Dysregulated Inflammatory Response Related to Cartilage Degradation after ACL Injury
Dysregulated Inflammatory Response Related to Cartilage Degradation after ACL Injury
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DOI：
10.1249/mss.0000000000002161
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发表时间：
2020-03-01
期刊：
影响因子：
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通讯作者：
Lattermann, Christian
中科院分区：
文献类型：
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作者：
Jacobs, Cale A.;Hunt, Emily R.;Lattermann, Christian
目的前交叉韧带 (ACL) 重建时滑液 (SF) 中促炎细胞因子、降解酶和软骨破坏标记物浓度升高与术后患者报告的结果和软骨质量较差相关。然而，目前尚不清楚这是由于更强烈或失调的炎症反应还是由于更严重的损伤所致。本研究的目的是评估 SF 的分子组成、患者人口统计数据和损伤特征与急性 ACL 损伤后软骨退化的关系。方法我们对促炎和抗炎细胞因子的 SF 浓度以及软骨退化、骨重塑和关节积血的生物标志物进行了聚类分析。我们评估了生物标志物簇与患者人口统计数据、受伤间隔天数、视觉模拟量表疼痛、SF 抽吸体积和磁共振成像测量的骨挫伤体积的关联。结果从本次分析中纳入的 35 名患者中发现了两个组：炎症失调和低度炎症。失调的炎症簇由 10 名患者组成，与低度炎症簇相比，软骨降解生物标志物的浓度显着较高（P < 0.05），并且抗炎与促炎细胞因子的比率较低（P = 0.053）。各组之间的患者人口统计数据、骨挫伤量、SF 抽吸量、疼痛和伴随损伤没有差异。结论 部分患者在急性 ACL 损伤后表现出炎症反应失调，这可能会增加创伤后骨关节炎的风险。这种反应似乎与损伤严重程度无关。
PurposeElevated synovial fluid (SF) concentrations of proinflammatory cytokines, degradative enzymes, and cartilage breakdown markers at the time of anterior cruciate ligament (ACL) reconstruction are associated with worse postoperative patient-reported outcomes and cartilage quality. However, it remains unclear if this is due to a more robust or dysregulated inflammatory response or is a function of a more severe injury. The objective of this study was to evaluate the association of the molecular composition of the SF, patient demographics, and injury characteristics to cartilage degradation after acute ACL injury. MethodsWe performed a cluster analysis of SF concentrations of proinflammatory and anti-inflammatory cytokines, and biomarkers of cartilage degradation, bony remodeling, and hemarthrosis. We evaluated the association of biomarker clusters with patient demographics, days between injury, Visual Analogue Scale pain, SF aspirate volumes, and bone bruise volumes measured on magnetic resonance imaging. ResultsTwo clusters were identified from the 35 patients included in this analysis, dysregulated inflammation and low inflammation. The dysregulated inflammation cluster consisted of 10 patients and demonstrated significantly greater concentrations of biomarkers of cartilage degradation (P < 0.05) as well as a lower ratio of anti-inflammatory to proinflammatory cytokines (P = 0.053) when compared with the low inflammation cluster. Patient demographics, bone bruise volumes, SF aspirate volumes, pain, and concomitant injuries did not differ between clusters. ConclusionsA subset of patients exhibited dysregulation of the inflammatory response after acute ACL injury which may increase the risk of posttraumatic osteoarthritis. This response does not appear to be a function of injury severity.