Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia.
Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia.
Am J Sports Med. 2021 Feb;49(2):391-403. doi: 10.1177/0363546520977505. Epub 2020 Dec 30.
BACKGROUND: Rupture of the anterior cruciate ligament (ACL) is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA), but patients with the "same injury" can have vastly different trajectories for the onset and progression of disease. Minor subcritical injuries preceding the critical injury event may drive this disparity through preexisting tissue pathologies and sensory changes. PURPOSE: To investigate the role of subcritical injury on ACL rupture risk and PTOA through the evaluation of pain behaviors, joint mechanics, and tissue structural change in a mouse model of knee injury. STUDY DESIGN: Controlled laboratory study. METHODS: Ten-week-old male C57BL/6J mice were allocated to naïve control and subcritical knee injury groups. Injury was induced by a single mechanical compression to the right hindlimb, and mice were evaluated using joint histopathology, anteroposterior joint biomechanics, pain behaviors (mechanical allodynia and hindlimb weightbearing), and isolated ACL tensile testing to failure at 1, 2, 4, or 8 weeks after injury. RESULTS: Subcritical knee injury produced focal osteochondral lesions in the patellofemoral and lateral tibiofemoral compartments with no resolution for the duration of the study (8 weeks). These lesions were characterized by focal loss of proteoglycan staining, cartilage structural change, chondrocyte pathology, microcracks, and osteocyte cell loss. Injury also resulted in the rapid onset of allodynia (at 1 week), which persisted over time and reduced ACL failure load ( = .006; mean ± SD, 7.91 ± 2.01 N vs 9.37 ± 1.01 N in naïve controls at 8 weeks after injury), accompanied by evidence of ACL remodeling at the femoral enthesis. CONCLUSION: The present study in mice establishes a direct effect of a single subcritical knee injury on the development of specific joint tissue pathologies (osteochondral lesions and progressive weakening of the ACL) and allodynic sensitization. These findings demonstrate a predisposition for secondary critical injuries (eg, ACL rupture) and an increased risk of PTOA onset and progression (structurally and symptomatically). CLINICAL RELEVANCE: Subcritical knee injuries are a common occurrence and, based on this study, can cause persistent sensory and structural change. These findings have important implications for the understanding of risk factors of ACL injury and subsequent PTOA, particularly with regard to prevention and management strategies following an often underreported event.
背景:前交叉韧带(ACL)撕裂是创伤后骨关节炎(PTOA)发展的一个众所周知的危险因素,但“相同损伤”的患者其疾病发作和进展的轨迹可能大不相同。在关键损伤事件之前发生的微小亚临界损伤可能通过预先存在的组织病理学和感觉变化来驱动这种差异。
目的:通过评估膝关节损伤小鼠模型中的疼痛行为、关节力学和组织结构变化,研究亚临界损伤对 ACL 撕裂风险和 PTOA 的作用。
研究设计:对照实验室研究。
方法:将 10 周龄雄性 C57BL/6J 小鼠分为正常对照组和亚临界膝关节损伤组。通过对右后肢进行单次机械压缩诱导损伤,在损伤后 1、2、4 或 8 周时,使用关节组织病理学、前后关节生物力学、疼痛行为(机械性感觉过敏和后肢负重)和 ACL 拉伸试验至失效来评估小鼠。
结果:亚临界膝关节损伤导致髌股和外侧胫股关节出现局灶性骨软骨病变,在整个研究期间(8 周)均未得到解决。这些病变的特征是蛋白聚糖染色丢失、软骨结构改变、软骨细胞病理学、微裂纹和骨细胞丢失。损伤还导致感觉过敏的快速发作(在 1 周时),并且随着时间的推移持续存在,导致 ACL 失效负荷降低(=.006;平均±标准差,7.91±2.01 N 与损伤后 8 周时正常对照组的 9.37±1.01 N),同时伴有股骨附着处 ACL 重塑的证据。
结论:本研究在小鼠中建立了单次亚临界膝关节损伤对特定关节组织病理学(骨软骨病变和 ACL 渐进性减弱)和感觉过敏的发展的直接影响。这些发现表明存在继发关键损伤(例如 ACL 撕裂)的倾向,以及 PTOA 发作和进展(结构和症状)的风险增加。
临床相关性:亚临界膝关节损伤很常见,根据这项研究,它会导致持续的感觉和结构变化。这些发现对于理解 ACL 损伤和随后的 PTOA 的危险因素具有重要意义,特别是在经常被低估的事件发生后,对于预防和管理策略具有重要意义。