Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA.
Department of Radiology, NYU Langone Medical Center, 660 First Ave, New York, NY, 10016, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1753-1760. doi: 10.1007/s00167-022-07045-9. Epub 2022 Jul 29.
The current investigation evaluated the relationship between the synovial fluid cytokine microenvironment at the time of isolated anterior cruciate ligament (ACL) reconstruction and the presence of subsequent chondral wear and radiologic evidence of osteoarthritis (OA) on cartilage-specific MRI sequences at a minimum of 5-year follow-up.
Patients who underwent primary ACL reconstruction with no baseline concomitant cartilage or meniscal defects and had synovial fluid samples obtained at the time of surgery were retrospectively identified. Patients with a minimum of 5 years of postoperative follow-up were contacted and asked to complete patient-reported outcome (PRO) measures including Visual Analog Scale (VAS) for pain, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale, along with postoperative magnetic resonance imaging (MRI). The concentration of ten biomarkers that have previously been suggested to play a role in cartilage degradation and inflammation in the joint space was measured. Linear regression controlling for age, sex, and body mass index (BMI) was performed to create a model using the synovial fluid concentrations at the time of surgery to predict postoperative semiquantitative cartilage lesion size and depth on MRI at a minimum of 5 years follow up.
The patients were comprised of eight males (44.4%) and ten females (55.6%) with a mean age at the time of surgery of 30.8 ± 8.7 years (range 18.2-44.5 years). The mean follow-up time was 7.8 ± 1.5 years post-operatively (range 5.7-9.7 years). MCP-1, VEGF, and IL-1Ra were found to have significant associations with the presence of postoperative cartilage wear (p < 0.05). No correlations were demonstrated among the biomarker concentrations at the time of injury with PRO scores at final follow-up (NS).
Synovial fluid inflammatory biomarker concentrations at the time of injury can predict progression of early-stage post-traumatic osteoarthritis at a mean of almost 8 years post-operatively. Findings from this study may help identify treatment targets to alter the natural history of cartilage loss following anterior cruciate ligament injury.
Level III, retrospective cohort study.
本研究旨在评估初次前交叉韧带（ACL）重建时关节滑液细胞因子微环境与术后至少 5 年软骨特异性 MRI 序列上软骨磨损和放射学骨关节炎（OA）证据之间的关系。
回顾性分析了行初次 ACL 重建且无基线合并软骨或半月板损伤、术中获得关节滑液样本的患者。对至少有 5 年术后随访的患者进行了联系，并要求其完成患者报告的结局（PRO）测量，包括疼痛的视觉模拟量表（VAS）、Lysholm 评分、膝关节损伤和骨关节炎结果评分（KOOS）以及 Tegner 活动量表，以及术后磁共振成像（MRI）。测量了先前被认为在关节腔内软骨降解和炎症中起作用的十种生物标志物的浓度。采用线性回归分析，控制年龄、性别和体重指数（BMI），使用手术时的关节滑液浓度建立模型，以预测术后至少 5 年的 MRI 上半定量软骨损伤大小和深度。
患者由 8 名男性（44.4%）和 10 名女性（55.6%）组成，手术时的平均年龄为 30.8±8.7 岁（18.2-44.5 岁）。平均术后随访时间为 7.8±1.5 年（5.7-9.7 年）。MCP-1、VEGF 和 IL-1Ra 与术后软骨磨损的存在具有显著相关性（p<0.05）。在受伤时的生物标志物浓度与最终随访时的 PRO 评分之间未显示出相关性（NS）。
受伤时的关节滑液炎症生物标志物浓度可以预测平均近 8 年后的早期创伤后骨关节炎的进展。本研究结果可能有助于确定治疗靶点，以改变前交叉韧带损伤后软骨丢失的自然史。
III 级，回顾性队列研究。
