Cartilage Repair Activity during Joint-Preserving Treatment May Be Accompanied by Osteophyte Formation
Cartilage Repair Activity during Joint-Preserving Treatment May Be Accompanied by Osteophyte Formation
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DOI：
10.3390/app11157156
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发表时间：
2021-08-01
影响因子：
2.7
通讯作者：
Lafeber, Floris P. J. G.
中科院分区：
文献类型：
--
作者：
Jansen, Mylene P.;Mastbergen, Simon C.;Lafeber, Floris P. J. G.
膝关节牵张（KJD）治疗显示骨关节炎患者的软骨修复和临床改善，胫骨高位截骨术（HTO）也是如此。KJD后，滑膜液（SF）中的TGF β-1和IL-6增加，这些因素与软骨再生有关，但也与骨赘形成有关。因此，研究了两种关节保留治疗后的骨赘形成。在治疗前、治疗后1年和2年测量放射学骨赘大小。在接受全膝关节置换术之前，将CHECK队列患者的变化与自然进展进行比较。另一个KJD队列接受SF抽吸，并将治疗期间1年Altman骨赘评分变化与SF标记物变化进行比较。两年后，KJD（n = 58）和HTO（n = 38）患者的骨赘大小均增加（分别为+6.2 mm（2）和+7.0 mm（2）;均P < 0.004），治疗之间无显著差异（P = 0.592）。未经治疗的腰椎间盘突出症患者（n = 44）没有显示出显著的两年变化（+2.1 mm（2）; p = 0.207），并且与KJD和HTO相比显示出显著差异（均p < 0.044）。在SF抽吸患者（n = 17）中，骨赘Altman评分降低、无变化或增加的患者之间TGF β-1变化（p = 0.044）存在显著差异，但IL-6（p = 0.898）无显著差异。由于KJD和HTO显示关节间隙增宽和临床改善伴有骨赘形成，因此关节保留治疗后骨赘增多可能是与关节内因子（如TGF β-1）相关的软骨修复活性的旁观者效应，并提出了骨赘形成作为关节退行性过程唯一特征的问题。
Knee joint distraction (KJD) treatment has shown cartilage repair and clinical improvement in patients with osteoarthritis, as has high tibial osteotomy (HTO). Following KJD, TGF beta-1 and IL-6 were increased in synovial fluid (SF), factors related to cartilage regeneration, but also to osteophyte formation. As such, osteophyte formation after both joint-preserving treatments was studied. Radiographic osteophyte size was measured before, one year, and two years after treatment. Changes were compared with natural progression in patients from the CHECK cohort before undergoing total knee arthroplasty. An additional KJD cohort underwent SF aspiration, and one-year Altman osteophyte score changes were compared to SF-marker changes during treatment. After two years, both KJD (n = 58) and HTO (n = 38) patients showed an increase in osteophyte size (+6.2 mm(2) and +7.0 mm(2) resp.; both p < 0.004), with no significant differences between treatments (p = 0.592). Untreated CHECK patients (n = 44) did not show significant two-year changes (+2.1 mm(2); p = 0.207) and showed significant differences with KJD and HTO (both p < 0.044). In SF aspiration patients (n = 17), there were significant differences in TGF beta-1 changes (p = 0.044), but not IL-6 (p = 0.898), between patients with a decrease, no change, or increase in osteophyte Altman score. Since KJD and HTO showed joint space widening and clinical improvement accompanied by osteophyte formation, increased osteophytosis after joint-preserving treatments may be a bystander effect of cartilage repair activity related to intra-articular factors like TGF beta-1 and raises questions regarding osteophyte formation as solely characteristic of the joint degenerative process.