Fukuda Hideaki, Sakuma Yoshihiro, Inage Kazuhide, Takahashi Kenji, Yamaura Ichiro, Shiratsuchi Hideaki, Ohtori Seiji
Sports Medicine and Joint Center, Inanami Spine and Joint Hospital, Tokyo, JPN.
Sports Medicine and Joint Center, Funabashi Orthopedic Hospital, Funabashi, JPN.
Cureus. 2025 Jan 20;17(1):e77734. doi: 10.7759/cureus.77734. eCollection 2025 Jan.
Background The development of subchondral insufficiency fracture (SIF) of the knee following a medial meniscal posterior root tear (MMPRT) results in pain and limitations in daily activities. Pain in patients with SIF is associated with local chronic inflammation in the knee joint, involving the production of inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and nerve growth factor (NGF). This study aimed to quantify the levels of proinflammatory cytokines (TNF-α, IL-6, NGF) in the injured medial meniscus (IMM) tissue of patients with knee SIF and examine their potential association with preoperative pain and functional scores. Methods Meniscus samples were collected from 17 patients with knee SIF (mean age: 62.8 ± 2.6 years) who underwent total knee arthroplasty. The tissue samples were categorized into two groups based on the degree of injury: the IMM and the non-injured healthy lateral meniscus (HLM) as the control group. The levels of TNF-α, IL-6, and NGF in both groups were measured using an enzyme-linked immunosorbent assay (ELISA), and differences were evaluated with the Wilcoxon signed-rank test. The association between preoperative functional and pain scores and the levels of each inflammatory mediator was analyzed using Spearman's correlation. Results TNF-α and IL-6 were detectable in the meniscus tissues, while NGF levels were negligible. The levels of TNF-α and IL-6 were significantly higher in the IMM group compared to the HLM group (p<0.05). Furthermore, TNF-α and IL-6 levels in the IMM group were correlated with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Conclusions This study demonstrated a significant increase in TNF-α and IL-6 cytokine levels in the IMM compared to the non-injured healthy meniscus. These findings suggest that inflammatory mediators within the IMM may be associated with preoperative pain in patients with SIF in the medial femoral condyle resulting from MMPRT.
背景 内侧半月板后根部撕裂（MMPRT）后膝关节软骨下不全骨折（SIF）的发生会导致疼痛和日常活动受限。SIF患者的疼痛与膝关节局部慢性炎症有关，涉及肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和神经生长因子（NGF）等炎性细胞因子的产生。本研究旨在量化膝关节SIF患者受伤内侧半月板（IMM）组织中促炎细胞因子（TNF-α、IL-6、NGF）的水平，并探讨它们与术前疼痛和功能评分的潜在关联。方法 收集17例行全膝关节置换术的膝关节SIF患者（平均年龄：62.8±2.6岁）的半月板样本。根据损伤程度将组织样本分为两组：IMM组和作为对照组的未受伤健康外侧半月板（HLM）组。采用酶联免疫吸附测定（ELISA）法测量两组中TNF-α、IL-6和NGF的水平，并采用Wilcoxon符号秩检验评估差异。使用Spearman相关性分析术前功能和疼痛评分与每种炎症介质水平之间的关联。结果 在半月板组织中可检测到TNF-α和IL-6，而NGF水平可忽略不计。与HLM组相比，IMM组中TNF-α和IL-6的水平显著更高（p<0.05）。此外，IMM组中TNF-α和IL-6的水平与西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的疼痛子量表相关。结论 本研究表明，与未受伤的健康半月板相比，IMM中TNF-α和IL-6细胞因子水平显著升高。这些发现表明，IMM内的炎症介质可能与MMPRT导致的股骨内侧髁SIF患者的术前疼痛有关。
