Murakami S, Muneta T, Furuya K, Saito I, Miyasaka N, Yamamoto H
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan.
Am J Sports Med. 1995 Nov-Dec;23(6):763-8. doi: 10.1177/036354659502300622.
To clarify the natural course of synovitis after anterior cruciate ligament injury, we took synovial tissues at various periods after injury and analyzed them immunohistologically. Twelve patients with isolated anterior cruciate ligament injuries participated in the study. Inflammation intensity was graded semiquantitatively based on the following parameters: synovial lining cell depth, synovial hyperplasia, vascular hyperplasia, lymphocyte infiltration, and the expression of cell adhesion molecules. The expression of fibrogenic cytokines and the degree of fibrosis were also investigated to elucidate the mechanisms of arthrofibrosis. The results demonstrated that synovitis in the infrapatellar fat pad subsides within 3 months after injury with the progression of fibrosis. Fibrogenic cytokines, platelet-derived growth factor and transforming growth factor-beta, were detected at fibrotic sites, suggesting their involvement in arthrofibrosis. An increased incidence of arthrofibrosis recently has been recognized to occur when anterior cruciate ligament reconstruction is performed within several weeks after injury. We speculate that when anterior cruciate ligament reconstruction is performed during the stage of acute synovitis, the operation may further promote the synovitis, accelerating the arthrofibrotic reaction. Waiting to perform the anterior cruciate ligament reconstruction until the synovitis resolves may possibly decrease the motion problems seen postoperatively.
为了阐明前交叉韧带损伤后滑膜炎的自然病程，我们在损伤后的不同时期采集滑膜组织并进行免疫组织学分析。12例单纯前交叉韧带损伤患者参与了本研究。根据以下参数对炎症强度进行半定量分级：滑膜衬里细胞深度、滑膜增生、血管增生、淋巴细胞浸润以及细胞黏附分子的表达。还研究了纤维化细胞因子的表达和纤维化程度，以阐明关节纤维化的机制。结果表明，髌下脂肪垫的滑膜炎在损伤后3个月内随着纤维化的进展而消退。在纤维化部位检测到纤维化细胞因子、血小板衍生生长因子和转化生长因子-β，提示它们参与了关节纤维化。最近人们认识到，在前交叉韧带损伤后数周内进行重建时，关节纤维化的发生率会增加。我们推测，在前交叉韧带重建手术在急性滑膜炎阶段进行时，手术可能会进一步促进滑膜炎，加速关节纤维化反应。等待至滑膜炎消退后再进行前交叉韧带重建可能会减少术后出现的活动问题。
