Abstract
BackgroundSynovial fluid was collected prior to and at 3 to 4 days after ACL reconstruction to investigate the correlation between inflammatory cytokine levels in the acute phase after surgery and physical functional recovery at 3 months postoperatively.Methods For this purpose, 79 patients with ACL reconstruction using semitendinosus tendons were included in the study. Median days from injury to surgery were 80 days (13–291 days). Synovial fluid was obtained just before surgery and at 3 to 4 days after surgery. Physical activity of each patient was evaluated at 3 months postoperatively, and scored from 0 (hard to walk) to 5 (run). Patients able to jog (score 4) or run (score 5) were considered as the “quick recovery” group and others (scores 1–3) as the “delayed recovery” group.ResultsPhysical activity recovery scores in the early surgery group (preoperative period less than 60 days; Group I) were significantly better than those in the delayed surgery group (Group II). Among the cytokines tested, TNF-alpha and IL10 levels in synovial fluid were significantly higher in Group II at 3 to 4 days postoperatively, while levels of these cytokines were quite comparable preoperatively between the groups. Increased IL1-beta expression was noted in the delayed recovery group at 3 to 4 days postoperatively. In addition, levels of IL6, IL10 and IFN-gamma also tended to increase in patients with delayed recovery.ConclusionDelayed ACL reconstruction increases levels of inflammatory cytokines in synovial fluid after surgery and correlates with a prolonged recovery of short-period physical activity of the patients.
Highlights
Synovial fluid was collected prior to and at 3 to 4 days after anterior cruciate ligament (ACL) reconstruction to investigate the correlation between inflammatory cytokine levels in the acute phase after surgery and physical functional recovery at 3 months postoperatively
A review article regarding the return to sports after ACL reconstruction revealed that on average, 81 % of patients returned to any sport, 65 % returned to their pre-injury level of sport, and 55 % returned to a competitive level sport after surgery (Ardern et al 2014; Petersen et al 2014)
Preoperative period, inflammatory reaction and pain are considered to affect the functional recovery after ACL reconstruction from the early phase (Czuppon et al 2014; Inoue et al Journal of Experimental Orthopaedics (2016) 3:30
Summary
Synovial fluid was collected prior to and at 3 to 4 days after ACL reconstruction to investigate the correlation between inflammatory cytokine levels in the acute phase after surgery and physical functional recovery at 3 months postoperatively. A systematic review classified the injury-to-surgery interval as either early (ranging from within 2 days to 7 months) or delayed (ranging from 3 weeks to 24 years) and found that 8 articles recommended early reconstruction, whereas the majority of the literature found no difference in outcome between early and delayed surgery (Andernord et al 2013). These indicate that the effect of the timing of surgery after injury is still controversy (Krutsch et al 2015; Kwok et al 2013). Our previous study suggested that osteopontin levels in synovial fluid are associated with the severity of joint pain and cartilage degradation after ACL rupture (Yamaga et al 2012)
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