Testa Edward J, Schmitt Phillip, Callanan Tucker C, Milner John D, Penvose Ian R, Owens Brett D
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Ann Jt. 2024 Sep 24;9:39. doi: 10.21037/aoj-24-12. eCollection 2024.
Angiotensin II receptor blockers (ARBs) are commonly prescribed for hypertension and heart failure, and have well-described antifibrotic properties throughout medical literature. The etiology and pathogenesis of fibrosis is biologically complex with a multitude of factors playing a role in the process. Consequently, pathologic fibrosis may be significant within orthopaedics contributing to post-operative stiffness and, ultimately, negative patient outcomes. The pharmacology of ARBs has been described to combat fibrosis in preclinical settings, while the literature of ARBs antifibrotic properties in relation to orthopaedics remains scarce. However, fibrosis is one of the primary factors contributing to tissue healing and functional recovery in the field of orthopaedic surgery. Fibrosis has specifically been described in relation to shoulder surgery, knee arthroplasty and hip arthroscopy. As such, outcomes of various orthopaedic surgeries are dependent upon a balance between tissue healing and stiffness, both of which may be mediated by a fibrotic response. Importantly, ARBs have recently emerged as a potential therapy to combat fibrosis-mediated stiffness in orthopaedic surgery patients. Thus, the following review article seeks to highlight the basic and clinical science of ARBs with emphasis on their implications and indications for orthopaedic surgery and musculoskeletal medicine.
血管紧张素II受体阻滞剂（ARBs）常用于治疗高血压和心力衰竭，并且在整个医学文献中都有关于其抗纤维化特性的详尽描述。纤维化的病因和发病机制在生物学上很复杂，有多种因素参与这一过程。因此，病理性纤维化在骨科领域可能很显著，会导致术后僵硬，并最终给患者带来不良后果。ARBs的药理学作用在临床前研究中已被描述为可对抗纤维化，而关于ARBs在骨科方面抗纤维化特性的文献仍然很少。然而，纤维化是影响骨外科手术中组织愈合和功能恢复的主要因素之一。纤维化尤其在肩部手术、膝关节置换术和髋关节关节镜检查中有所描述。因此，各种骨科手术的结果取决于组织愈合和僵硬之间的平衡，而这两者都可能由纤维化反应介导。重要的是，ARBs最近已成为一种治疗骨外科手术患者中由纤维化介导的僵硬的潜在疗法。因此，以下综述文章旨在突出ARBs的基础和临床科学，重点阐述其对骨科手术和肌肉骨骼医学的影响及适应症。
