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膝关节创伤后韧带损伤关节镜检查时意外发现类风湿关节炎

Incidental Arthroscopic Finding of Rheumatoid Arthritis in a Post-traumatic Ligamentous Injury to Knee Joint.

作者信息

Kembhavi Raghavendra, Bagewadi Rajakumar M, Hublikar Anmol A, Nerune Savitri M

机构信息

Department of Orthopaedics, Shri B. M. Patil Medical College, BLDE (Deemed to be University), Vijayapura, Karnataka, India.

Department of Pathology, Shri B. M. Patil Medical College, BLDE (Deemed to be University), Vijayapura, Karnataka, India.

出版信息

J Orthop Case Rep. 2024 May;14(5):88-93. doi: 10.13107/jocr.2024.v14.i05.4444.

Abstract

INTRODUCTION

The relationship between physical trauma and subsequent symptoms of rheumatoid arthritis (RA) has been described in the past though onset of newer disease of RA in apparently normal patient is doubtful. Trauma can cause precipitation of RA symptoms. Such trauma includes fractures, joint injuries, road traffic accidents, and also surgeries and deliveries. Although post-traumatic osteoarthritis following anterior cruciate ligament (ACL) injury is more common pathology, association of RA following ACL injury has not been reported in the literature. This case report highlights on one rare incidental diagnosis of RA postoperatively in a patient with traumatic ACL tear with previously no features of RA and how patient was managed successfully both by surgical and by medical management.

CASE REPORT

A 30-year-old male patient presented to us with complaints of pain over right knee associated with recurrent swelling, instability, clicking sounds, and occasional locking episodes since 6 months following twisting injury with no other symptoms in other joints of the body. Based on clinicoradiological workup, the diagnosis of traumatic complete ACL tear with medial meniscus bucket handle tear of body and posterior horn with early osteoarthritic changes was made. The patient was operated with ACL reconstruction with quadrupled hamstring graft, partial medial meniscectomy and debridement + microfracture for cartilage defects. The patient was worked up for inflammatory arthritis post operatively considering unusual synovitis of knee. Based on histopathological and serological investigations (rheumatoid factor and anticitrullinated protein antibody), the patient was put on disease modifying antirheumatoid drugs for 1 year. At 1-year follow-up, the patient was back to his normal activities with full range of movements with Lysholm Knee Score of 89.

CONCLUSION

Traumatic ACL tear can result in onset of RA following trauma and needs to be worked up further when there are findings of unusual synovitis or cartilage damage arthroscopically. Such association is rare and concomitant diagnosis of RA or other inflammatory arthritis can be easily missed out if not addressed properly.

摘要

引言

过去曾描述过身体创伤与类风湿关节炎(RA)后续症状之间的关系,不过在看似正常的患者中出现新的RA疾病发病情况仍存在疑问。创伤可导致RA症状的发作。此类创伤包括骨折、关节损伤、道路交通事故,以及手术和分娩。虽然前交叉韧带(ACL)损伤后创伤性骨关节炎是更常见的病理情况,但ACL损伤后发生RA的关联在文献中尚未见报道。本病例报告重点介绍了一名患有创伤性ACL撕裂且既往无RA特征的患者术后罕见的RA偶然诊断情况,以及该患者如何通过手术和药物治疗成功得到管理。

病例报告

一名30岁男性患者因右膝疼痛伴反复肿胀、不稳定、弹响及偶尔的绞锁发作前来就诊,自6个月前扭伤后出现这些症状,身体其他关节无其他症状。基于临床放射学检查,诊断为创伤性完全ACL撕裂伴内侧半月板体部和后角桶柄状撕裂以及早期骨关节炎改变。患者接受了四股腘绳肌肌腱移植的ACL重建术、部分内侧半月板切除术、清创术以及针对软骨缺损的微骨折术。术后考虑到膝关节异常滑膜炎,对患者进行了炎性关节炎检查。基于组织病理学和血清学检查(类风湿因子和抗瓜氨酸化蛋白抗体),患者接受了1年的改善病情抗风湿药物治疗。在1年随访时,患者恢复正常活动,活动范围完全正常,Lysholm膝关节评分为89分。

结论

创伤性ACL撕裂可导致创伤后发生RA,当关节镜检查发现异常滑膜炎或软骨损伤时需要进一步检查。这种关联很罕见,如果处理不当,RA或其他炎性关节炎的伴随诊断很容易被遗漏。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9de1/11111253/3eec55f10ac3/JOCR-14-88-g001.jpg

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