Sánchez Mikel, Yarza Izarbe, Jorquera Cristina, Aznar Jose María, de Dicastillo Leonor López, Valente Cristina, Andrade Renato, Espregueira-Mendes João, Celorrio David, Aizpurua Beatriz, Azofra Juan, Delgado Diego
Arthroscopic Surgery Unit Hospital Vithas Vitoria Vitoria-Gasteiz Spain.
Advanced Biological Therapy Unit Hospital Vithas Vitoria Vitoria-Gasteiz Spain.
J Exp Orthop. 2025 Jan 28;12(1):e70156. doi: 10.1002/jeo2.70156. eCollection 2025 Jan.
To identify genes and patient factors that are related to the development of arthrofibrosis in patients after anterior cruciate ligament (ACL) reconstruction and to develop a prognostic model.
The study included patients diagnosed with ACL injury who underwent ACL reconstruction. Patients were enroled consecutively and divided into non-fibrotic (controls) and fibrotic (cases) groups until a balanced sample of matched case-control was achieved. Arthrofibrosis was considered pathological if the range of motion achieved 3 months after surgery decreased by at least 25% compared to its initial full range of motion. Patient variables and saliva samples were collected from each patient to perform a genetic approach by screening a set of candidate genes implicated in arthrofibrosis. Chi-squared was used to analyze the association between the development of arthrofibrosis and different independent variables. Binary logistic regression was used to develop a prognostic algorithm.
A total of 45 controls (non-fibrotic patients) (50.1%) and 44 cases (fibrotic patients) (49.9%) were included for analysis. The median age was 34.0 years (95% confidence interval = 29.0-38.0) and the number of women was 32 (35.9%). Seven genetic polymorphisms showed significant association with the development of arthrofibrosis ( < 0.05). After binary regression analysis, the regression model included the polymorphisms rs4343 (ACE), rs1800947 (CRP), rs8032158 (NEDD4) and rs679620 (MMP3). This analysis also indicated that female gender was a risk factor while the use of platelet-rich plasma (PRP) during surgery was a preventive factor ( < 0.05).
Genetic alterations involved in inflammation and extracellular matrix turnover predispose to the development of arthrofibrosis after ACL reconstruction. Female sex was a risk factor in the development of this condition, while the application of PRP provided a preventive effect. The combination of patient and genetic variants of a patient allows the development of a prognostic algorithm for the risk of post-surgical arthrofibrosis.
level III.
确定与前交叉韧带（ACL）重建术后患者关节纤维化发展相关的基因和患者因素，并建立一个预后模型。
该研究纳入了诊断为ACL损伤并接受ACL重建的患者。患者连续入组并分为非纤维化（对照组）和纤维化（病例组）两组，直至获得匹配的病例对照平衡样本。如果术后3个月达到的活动范围与其初始全活动范围相比减少至少25%，则认为关节纤维化是病理性的。从每位患者收集患者变量和唾液样本，通过筛选一组与关节纤维化相关的候选基因进行基因研究。采用卡方检验分析关节纤维化发展与不同自变量之间的关联。使用二元逻辑回归建立预后算法。
共纳入45例对照（非纤维化患者）（50.1%）和44例病例（纤维化患者）（49.9%）进行分析。中位年龄为34.0岁（95%置信区间=29.0-38.0），女性患者有32例（35.9%）。七种基因多态性与关节纤维化的发展显著相关（P<0.05）。经过二元回归分析，回归模型包括多态性rs4343（ACE）、rs1800947（CRP）、rs8032158（NEDD4）和rs679620（MMP3）。该分析还表明，女性是一个危险因素，而手术期间使用富血小板血浆（PRP）是一个预防因素（P<0.05）。
参与炎症和细胞外基质周转的基因改变易导致ACL重建术后关节纤维化的发展。女性是这种情况发展的危险因素，而PRP的应用具有预防作用。患者因素与患者基因变异的结合有助于建立术后关节纤维化风险的预后算法。
三级。
