Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):300-309. doi: 10.1007/s00167-020-06037-x. Epub 2020 May 6.
The primary aim of this study was to assess the relationship between the metabolites lactate and pyruvate in the healing tendon after Achilles tendon rupture (ATR) and patient-reported outcome at 6 and 12 months. A secondary aim was to evaluate which underlying factors regulate lactate and pyruvate concentrations.
Lactate and pyruvate concentrations were measured two weeks post-operatively in both the healing- and healthy Achilles tendon in 109 patients (90 men, 19 women; mean age 40 ± 7.9 years). Patient demographics, degree of physical activity, timing of surgery, operation time, patient-reported loading and step counts were investigated in relation to metabolite concentrations. At 6 and 12 months, the Achilles tendon Total Rupture Score (ATRS) questionnaire was used to assess patient outcome.
The mean number of steps taken during the post-operative days 1-10 was the only factor significantly related to the mean concentration of lactate (R = 0.34, p = 0.038), and pyruvate (R = 0.46, p = 0.006). Pyruvate was demonstrated as the only factor significantly associated with ATRS at both 6 months (R = 0.32, p = 0.003) and at 12 months (R = 0.37, p = 0.004) using multiple linear regression.
The mean concentration of pyruvate during early ATR healing may predict patient outcome at 6 and 12 months post-operatively and possibly be used as a biomarker of healing. Early mobilization with an increased number of steps taken is an important clinical strategy to improve the metabolite concentrations during healing.
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本研究的主要目的是评估跟腱断裂（ATR）后愈合肌腱中乳酸和丙酮酸代谢物与患者 6 个月和 12 个月时报告的结果之间的关系。次要目的是评估哪些潜在因素调节乳酸和丙酮酸的浓度。
109 例患者（90 名男性，19 名女性；平均年龄 40±7.9 岁）在术后两周时分别测量愈合和健康的跟腱中的乳酸和丙酮酸浓度。调查患者的人口统计学数据、身体活动程度、手术时机、手术时间、患者报告的负荷和步数与代谢物浓度的关系。在 6 个月和 12 个月时，使用跟腱总断裂评分（ATRS）问卷评估患者的结果。
术后第 1-10 天的平均步数是与乳酸（R=0.34，p=0.038）和丙酮酸（R=0.46，p=0.006）平均浓度唯一显著相关的因素。丙酮酸是与 6 个月（R=0.32，p=0.003）和 12 个月（R=0.37，p=0.004）时 ATRS 显著相关的唯一因素，采用多元线性回归。
跟腱断裂愈合早期丙酮酸的平均浓度可能预测术后 6 个月和 12 个月的患者结果，并可能作为愈合的生物标志物。增加所走的步数，早期进行活动是改善愈合过程中代谢物浓度的重要临床策略。
III。
