Relationship between synovial fluid biomarkers of articular cartilage metabolism and the patient's perspective of outcome depends on the severity of articular cartilage damage following ACL trauma.
Relationship between synovial fluid biomarkers of articular cartilage metabolism and the patient's perspective of outcome depends on the severity of articular cartilage damage following ACL trauma.
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关节软骨代谢的滑液生物标志物与患者对结果的看法之间的关系取决于 ACL 创伤后关节软骨损伤的严重程度。
DOI：
10.1002/jor.23084
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Beynnon,BruceD
中科院分区：
文献类型：
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作者：
Wasilko,ScottM;Tourville,TimothyW;DeSarno,MichaelJ;Slauterbeck,JamesR;Johnson,RobertJ;Struglics,André;Beynnon,BruceD
前交叉韧带（ACL）创伤通常与膝关节软骨损伤合并发生，这可能导致与对侧ACL完整膝关节相比，膝关节创伤后骨关节炎（OA）的放射学证据更早;然而，与这种疾病的发生和进展相关的生物力学和生物学机制尚不清楚。我们试图通过确定与ACL创伤相关的关节软骨损伤与关节软骨代谢的滑液生物标志物表达之间的关系来深入了解机制，并评估这些生物标志物与患者对结果的看法之间的关系。滑膜液样本采集自39名ACL损伤受试者，平均损伤后10周，和32名正常膝关节的对照受试者（记录临床检查和MRI评估）。如果ACL损伤组中的受试者显示出国际腕关节修复学会（ICRS）2级或更低的关节软骨病变，则将其归类为未来OA的低风险，如果他们有ICRS 3A级关节软骨病变，则将其归类为未来OA的高风险。采用膝关节损伤和骨关节炎结局评分（KOOS）评价患者对损伤的看法。对照受试者与低风险组和高风险组受试者之间的II型胶原代谢标志物（CPII、C2C和C1，2C）或聚集蛋白聚糖分解丙氨酸-精氨酸-甘氨酸-丝氨酸（ARGS）片段的平均浓度无显著差异（p值范围：0.80-0.43）。ARGS-聚集蛋白聚糖浓度与KOOS症状和疼痛子量表之间的相关性在低风险组和高风险组之间存在显著差异（分别为p = 0.03和p = 0.01）。同样，有强有力的证据支持低风险组和高风险组之间II型胶原代谢标志物（C1、2C和CPII浓度）与KOOS疼痛子量表之间的相关性（相应p= 0.051和0.077）。在伴有3A级关节软骨损伤的ACL损伤受试者中，滑液ARGS-聚集蛋白聚糖浓度与KOOS症状和疼痛改善直接相关。这些发现表明，ARGS‐聚集蛋白聚糖可能参与了局部组织修复反应，涉及严重膝关节创伤后聚集蛋白聚糖周转增加。© 2015骨科研究学会。由威利期刊公司出版J Orthop Res 34：820-827，2016.
Anterior cruciate ligament (ACL) trauma often occurs in combination with injury to the articular cartilage of the knee, this can result in earlier radiographic evidence of post traumatic osteoarthritis (OA) of the knee compared to the contralateral, ACL intact knee; however, the biomechanical and biological mechanisms associated with the onset and progression of this disease are not understood. We sought to gain insight into the mechanisms by determining the relationship between articular cartilage injury associated with ACL trauma and the expression of synovial fluid biomarkers of articular cartilage metabolism, and to evaluate the relationship between these biomarkers and the patient's perspective of the outcomes. Synovial fluid samples were acquired from 39 ACL injured subjects at an average of 10 weeks after injury, and 32 control subjects with normal knees (documented with clinical exam and MRI assessment). Subjects in the ACL‐injured group were classified as low‐risk for future OA if they displayed an International Cartilage Repair Society (ICRS) Grade 2 articular cartilage lesion or less and high‐risk for future OA if they had an ICRS Grade 3A articular cartilage lesion. The patient's perspective of the injury was evaluated with the Knee Injury and Osteoarthritis Outcomes Score (KOOS). There were no significant differences in mean concentrations of the markers of type II collagen metabolism (CPII, C2C, and C1,2C) or the aggrecan breakdown Alanine–Arginine–Glycine–Serine (ARGS) ‐fragment between control subjects and the subjects in the low‐ and high‐risk groups (p‐value range: 0.80–0.43). Associations between ARGS‐aggrecan concentration and KOOS subscales of symptoms and pain were significantly different between the low‐ and high‐risk groups (p = 0.03 and p = 0.01, respectively). Likewise, there was strong evidence in support of an association between the markers of type II collagen metabolism (C1,2C and CPII concentrations) and the KOOS subscale of pain between the low‐ and high‐risk groups (p= 0.051 and 0.077, correspondingly). In ACL injured subjects with concomitant Grade 3A articular cartilage injuries, concentrations of synovial fluid ARGS‐aggrecan were directly associated with improvements in KOOS symptoms and pain. These findings suggest the possible involvement of ARGS‐aggrecan in a localized tissue repair response involving an increase in aggrecan turnover following severe knee trauma. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:820–827, 2016.