Department of Rehabilitation Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
J Orthop Res. 2022 Sep;40(9):2015-2024. doi: 10.1002/jor.25236. Epub 2021 Dec 11.
Inflammation-predominant osteoarthritis is an important clinical type of osteoarthritis, with synovitis suggested as its distinct pathophysiology. We investigated whether the synovium's mechanical properties in knees differed by osteoarthritis and other clinical parameters through retrospectively analyzing intra-articular pressure-volume characteristics. We analyzed 60 knees that were administered intra-articular corticosteroids while undergoing pressure monitoring. McMurray's test, pain complaints at end-range knee flexion, Kellgren-Lawrence classification from standing anteroposterior radiographs, and suprapatellar effusion from ultrasound constituted clinical parameters. Pressure-volume profiles-phasic changes in pressure by volume infusion, the volume of Phase 1-the potential volume of the synovial space, the pressure at 45 ml infusion-intra-articular pressure at a standardized volume, and the slope of Phase 2-synovial stiffness were compared with clinical parameters. All graphs were biphasic. Knees with suprapatellar effusion or radiologically definite osteoarthritis (Kellgren-Lawrence grade ≥2), had a lower Phase 1 volume. Knees with definite radiographic osteoarthritis also showed higher pressures at 45 ml and Phase 2 slopes (171.11 ± 94.35 mmHg and 5.08 ± 3.07 mmHg/ml, respectively) than those without (101.88 ± 58.12 mmHg and 2.84 ± 1.27 mmHg/ml, respectively). The Phase 2 slope was higher for knees with positive provocative tests than in those with negative provocative tests, although not statistically significant. The synovium stretched earlier in knees with effusion or radiologically definite osteoarthritis. Intra-articular pressure and synovial stiffness were significantly higher in patients with radiologically definite osteoarthritis. The synovium's mechanical characteristics are altered by osteoarthritis of the knee joint. Intra-articular pressure characteristics could be utilized for synovial evaluation clinically.
炎症为主型骨关节炎是骨关节炎的一种重要临床类型，滑膜炎被认为是其独特的病理生理学基础。我们通过回顾性分析关节内压力-容积特征，研究膝关节滑膜炎的机械特性是否因骨关节炎和其他临床参数而不同。我们分析了 60 例接受关节内皮质类固醇注射同时进行压力监测的膝关节。麦氏征检查、膝关节终末屈曲时的疼痛主诉、站立前后位 X 线片的 Kellgren-Lawrence 分级和超声检查的髌上囊积液构成了临床参数。压力-容积曲线分析（容积输注时压力的阶段性变化、相 1 的容积-滑膜腔的潜在容积、45ml 输注时的压力-标准化容积时的关节内压力和相 2 的斜率-滑膜硬度）与临床参数进行了比较。所有曲线均呈双相性。髌上囊积液或影像学明确的骨关节炎（Kellgren-Lawrence 分级≥2）的膝关节相 1 容积较低。影像学明确的骨关节炎膝关节在 45ml 时的压力和相 2 斜率也较高（分别为 171.11±94.35mmHg 和 5.08±3.07mmHg/ml），而无骨关节炎的膝关节压力和相 2 斜率分别为 101.88±58.12mmHg 和 2.84±1.27mmHg/ml。阳性激发试验的膝关节相 2 斜率高于阴性激发试验，但差异无统计学意义。髌上囊积液或影像学明确的骨关节炎的膝关节滑膜更早拉伸。膝关节有明确影像学表现的骨关节炎患者关节内压力和滑膜硬度明显升高。膝关节滑膜炎的机械特性因膝关节骨关节炎而改变。关节内压力特征可用于临床评估滑膜。
