Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan.
Cartilage. 2022 Jul-Sep;13(3):19476035221118171. doi: 10.1177/19476035221118171.
The purpose of this study was to evaluate the postoperative status of spontaneous osteonecrosis of the knee (SONK) after high tibial osteotomy (HTO) with concomitant bone marrow stimulation (BMS) using synovial fluid (SF) biomarkers.
Twenty patients with SONK who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee were collected at the time of HTO surgery and at the time of plate removal. SF concentrations of interleukin (IL)-6, IL-8, and matrix metalloproteinase (MMP)-13 were measured by enzyme-linked immunosorbent assays. The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO.
The KSS knee and function scores were significantly improved after HTO (mean changes of 33.8 and 29.4, respectively). The mean HKA angle was changed from mechanical varus (-8.6°) to valgus (5.2°). Concentrations of IL-6, IL-8, and MMP-13 were significantly decreased after HTO (mean changes of -73.7%, -32.4%, and -47.9% from preoperative baseline, respectively). Significant correlations were found between lesion size and concentrations of biomarkers, except for preoperative MMP-13.
SF levels of biomarkers of inflammation and cartilage degradation were reduced after HTO with a concomitant BMS procedure, suggesting a biological improvement in SONK.
本研究旨在通过滑液（SF）生物标志物评估伴骨髓刺激（BMS）的胫骨高位截骨术（HTO）后自发性膝关节坏死（SONK）的术后状态。
共纳入 20 例 SONK 患者，行开放式楔形 HTO。在 HTO 手术时和钢板取出时采集患膝配对 SF 样本。通过酶联免疫吸附试验测量 SF 中白细胞介素（IL）-6、IL-8 和基质金属蛋白酶（MMP）-13 的浓度。在 HTO 前和 2 年后评估膝关节学会评分（KSS）和髋膝踝（HKA）角。
HTO 后 KSS 膝关节和功能评分显著改善（分别平均改善 33.8 和 29.4）。平均 HKA 角从机械性内翻（-8.6°）变为外翻（5.2°）。HTO 后 IL-6、IL-8 和 MMP-13 的浓度显著降低（分别从术前基线下降 73.7%、32.4%和 47.9%）。除了术前 MMP-13 外，病变大小与生物标志物浓度之间存在显著相关性。
HTO 伴 BMS 术后 SF 中炎症和软骨降解生物标志物的水平降低，提示 SONK 生物学改善。
