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Concentration of synovial fluid biomarkers on the day of anterior cruciate ligament (ACL)-reconstruction predict size and depth of cartilage lesions on 5-year follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The current investigation evaluated the relationship between the synovial fluid cytokine microenvironment at the time of isolated anterior cruciate ligament (ACL) reconstruction and the presence of subsequent chondral wear and radiologic evidence of osteoarthritis (OA) on cartilage-specific MRI sequences at a minimum of 5-year follow-up.

Methods

Patients who underwent primary ACL reconstruction with no baseline concomitant cartilage or meniscal defects and had synovial fluid samples obtained at the time of surgery were retrospectively identified. Patients with a minimum of 5 years of postoperative follow-up were contacted and asked to complete patient-reported outcome (PRO) measures including Visual Analog Scale (VAS) for pain, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale, along with postoperative magnetic resonance imaging (MRI). The concentration of ten biomarkers that have previously been suggested to play a role in cartilage degradation and inflammation in the joint space was measured. Linear regression controlling for age, sex, and body mass index (BMI) was performed to create a model using the synovial fluid concentrations at the time of surgery to predict postoperative semiquantitative cartilage lesion size and depth on MRI at a minimum of 5 years follow up.

Results

The patients were comprised of eight males (44.4%) and ten females (55.6%) with a mean age at the time of surgery of 30.8 ± 8.7 years (range 18.2–44.5 years). The mean follow-up time was 7.8 ± 1.5 years post-operatively (range 5.7–9.7 years). MCP-1, VEGF, and IL-1Ra were found to have significant associations with the presence of postoperative cartilage wear (p < 0.05). No correlations were demonstrated among the biomarker concentrations at the time of injury with PRO scores at final follow-up (NS).

Conclusion

Synovial fluid inflammatory biomarker concentrations at the time of injury can predict progression of early-stage post-traumatic osteoarthritis at a mean of almost 8 years post-operatively. Findings from this study may help identify treatment targets to alter the natural history of cartilage loss following anterior cruciate ligament injury.

Level of evidence

Level III, retrospective cohort study.

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Funding

Funding for this study was received from Arthroscopy Association of North America, Rosemont, IL, USA (Grant no. SOM01-15-C-39000-NYUPG-115854).

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Authors and Affiliations

  1. Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA

    Danielle H. Markus, Eoghan T. Hurley, Edward S. Mojica, Utkarsh Anil, Ajay Kanakamedala, Amanda Avila & Eric J. Strauss

  2. Department of Radiology, NYU Langone Medical Center, 660 First Ave, New York, NY, 10016, USA

    Soterios Gyftopoulos

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  1. Danielle H. Markus
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Correspondence to Danielle H. Markus.

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Markus, D.H., Hurley, E.T., Mojica, E.S. et al. Concentration of synovial fluid biomarkers on the day of anterior cruciate ligament (ACL)-reconstruction predict size and depth of cartilage lesions on 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 31, 1753–1760 (2023). https://doi.org/10.1007/s00167-022-07045-9

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