The influence of synovial inflammation and hyperplasia on symptomatic outcomes up to 2 years post-operatively in patients undergoing partial meniscectomy.
The influence of synovial inflammation and hyperplasia on symptomatic outcomes up to 2 years post-operatively in patients undergoing partial meniscectomy.
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DOI：
10.1016/j.joca.2013.05.011
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发表时间：
2013-09
影响因子：
7
通讯作者：
McKeon, B.
中科院分区：
文献类型：
--
作者：
Scanzello, C. R.;Albert, A. S.;DiCarlo, E.;Rajan, K. B.;Kanda, V.;Asomugha, E. U.;Swaim, B. H.;Katz, J. N.;Goldring, S. R.;Richmond, J. C.;McKeon, B.
滑膜炎与膝骨关节炎患者的疼痛和其他症状有关，甚至在没有放射线检查的骨关节炎患者中，也与半月板撕裂的患者有关。对接受关节镜部分半月板切除术的患者进行了两年的随访，以确定滑膜炎是否可以预测术后症状。这项试点研究招募了 33 名计划接受关节镜检查的患者。术前以及术后 16 周、1 年和 2 年使用膝关节疼痛量表、Lysholm 评分和 SF-12® 评估症状。根据手术活检对滑膜炎症和增生进行分级。测试线性混合效应模型以确定炎症或增生是否与随时间变化的结果评分相关。炎症患者术前 Lysholm 评分和 SF-12® 身体成分评分较差（Lysholm：52.42 [95% CI 42.37,62.47] 对比 72.38 [66.03,78.72]，p<0.001；SF-12：36.81 [28.26,45.37] 对比46.23 [40.14,52.32]，p<0.05）。术后两年，有炎症的患者的平均评分与无炎症的患者相似。结果，Lysholm 评分的平均改善比无炎症患者高 13.01 [1.48–24.53] 分，p = 0.03。 33% (4/12) 的炎症患者在术后两年内 Lysholm 评分仍为较差，而无炎症患者的 Lysholm 评分为 7% (1/15, (p=0.14)。未发现增生与症状之间存在关联。在这项针对接受部分半月板切除术的患者的初步研究中，滑膜炎症与术前症状恶化相关，但与头两年的预后不良无关 关节镜检查后。应进行更大的队列和更长时间的随访来确认这种关系，并确定最初的反应是否持续。
Synovitis is associated with pain and other symptoms in patients with knee OA, and in patients with meniscal tears even in the absence of radiographic OA. Patients undergoing arthroscopic partial meniscectomy were followed for 2 years to determine whether synovitis predicts post-operative symptoms. Thirty-three patients scheduled for arthroscopy were recruited for this pilot study. Symptoms were assessed using a knee pain scale, the Lysholm score, and the SF-12® pre-operatively and at 16 weeks, 1 year and 2 years post-operatively. Synovial inflammation and hyperplasia were graded on surgical biopsies. Linear mixed effects models were tested to determine whether inflammation or hyperplasia is associated with outcome scores over time. Lysholm scores and SF-12® physical component sub-scores were worse pre-operatively in patients with inflammation (Lysholm: 52.42 [95%CI 42.37,62.47] vs. 72.38 [66.03,78.72], p<0.001; SF-12: 36.81 [28.26,45.37] vs 46.23 [40.14,52.32], p<0.05). Up to two-years post- operatively, patients with inflammation achieved mean scores similar to those without inflammation. As a result, the mean improvement in Lysholm scores was 13.01 [1.48–24.53] points higher than patients without inflammation, p = 0.03. 33% (4/12) of patients with inflammation still had fair-to-poor Lysholm scores two years after surgery compared to 7% (1/15, (p=0.14) without inflammation. No association between hyperplasia and symptoms was noted. In this pilot study of patients undergoing partial meniscectomy, synovial inflammation was associated with worse pre-operative symptoms, but not with poorer outcomes in the first two years post-arthroscopy. Larger cohorts and longer follow-up should be pursued to confirm this relationship, and determine if the initial response is sustained.
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