Incidence Of Degenerative Changes Research Articles

Degenerative Changes of Buccal Cells After One Cycle of Chemotherapy on Male Breast Cancer Patients

Introduction: Micronucleus test (MN) in buccal cells of the mouth presents a new road on the way of studying the degenerative changes directly in the targeted organs which were impacted by the tumoral diseases. Aim of the study: This paper aims to analyze the incidence of the test micronucleus in the epithelial cells of the buccal mucosa of the oral cavity in male patients with breast carcinoma after a cycle of chemotherapy. Material and Methods: In the study, 40 male patients with breast cancer with an average age of 45.8±15.5 years were taken for analysis. From the measured parameters, we analyzed the incidence of degenerative changes and the effect of chemotherapy, after one cycle of chemotherapy. Results: The average number of deteriorative modifications in the exfoliative cells deriving from the buccal mucosa of breast cancer patients, increased significantly after a single cycle of chemotherapy with 15.5±22.4 being the number of degenerated cells before treatments and 27.5±30.1 after the first cycle of chemotherapy, p<0.0002. A significant increase was noticed in all types of nuclear degenerations. The incidence of acute nuclear changes as well as the total number of these modifications was high in males diagnosed with breast carcinoma Conclusion: The results show that cytostatic drugs induced cellular cytotoxicity. However, it did not significantly change chromosomal changes or the micronuclei formation.

Measurement of the trabecular bone structure of the TMJ region in patients with transverse maxillary deficiency: a CBCT fractal analysis study

This study aimed to evaluate the effect of transverse maxillary deficiency on condylar morphology via visual examination and fractal analysis of cone beam computed tomography (CBCT) scans. In total, 97 patients with posterior crossbite or maxillary narrowness and 36 control patients were included. The presence of degenerative changes in the bilateral condyles was evaluated with CBCT. Fractal dimension (FD) was calculated on the condylar images using ImageJ. Degenerative bone changes were discovered in 38 of the 133 scans (28.6%). There was no significant difference between the groups in terms of the incidence of degenerative changes for either the right or left sides (P ≥ .670). In coronal sections and in mean measurements, FD was significantly lower in the control group compared with the other groups in the right condyle (P ≤ .031). No significant differences were found between the mean FD values of the condyles with degenerative bone changes or the mean FD values of the normal condyles (P ≥ .256). In the presence of maxillary transverse deficiencies, degenerative bone changes in the mandibular condyle were not significantly different, but the FD of the right condyle was found to be higher compared with the control group.

Combined Intra-articular and Extra-articular Reconstruction in Anterior Cruciate Ligament–Deficient Knee: 25 Years Later

To determine whether an anterior cruciate ligament (ACL)-reconstructed knee with hamstring autograft has a greater incidence of degenerative changes when an extra-articular reconstruction is added and to determine the effect of the combined reconstruction on knee stability and function at long-term follow-up. For this retrospective study, patients who underwent ACL reconstruction between January 2002 and December 2003 were selected and classified into 2 groups, I and II. Group I consisted of patients operated by a standard ACL reconstruction, and group II consisted of patients in whom, owing to the presence of risk factors (severe pivot shift graded+++ or high-risk sports), an extra-articular reconstruction performed with ileo-tibial tract according to McIntosh as modified by Cocker Arnold technique, was used in conjunction with intra-articular ACL reconstruction. At final follow-up, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores were used. An arthrometric KT-1000 evaluation was done. Comparative weight-bearing radiographs were taken, including a skyline view for the patellofemoral joint and analyzed according to Fairbank, Kellgren, and IKDC classification. Seventy-two of the 75 (96%) patients in group I and 68 of the 75 patients in group II were available at the final follow-up (minimum 10years). Subjective scores improved significantly in both groups, with no significant difference. Objectively, the number of patients receiving C and D IKDC objective activity scores in group I (7/56; 12.5%) was significantly higher than in group II (0/60) (P= .01). Considering as a failure a side-to-side arthrometric difference more than 5mm or a pivot shift test graded as++ or+++, or any giving way episode occurring postoperatively, we found 8 cases in group I and no cases in group II (P= .01) despite the presence of risk factors that group I did not include. Radiologic evaluation showed less arthritic changes in group II in both tibiofemoral and patellofemoral joints. On the basis of the results of this study, adding an extra-articular reconstruction to an anatomically placed intra-articular ACL reconstruction, followed by a modern rehabilitation protocol, does not increase the risk of osteoarthritis and may be able to reduce the rate of failure. Level III, retrospective comparative study.

Surgical Reconstruction in Chronic Posterior Cruciate Ligament Injuries of the Knee

Introduction: This is a cross-sectional study to evaluate the outcome of posterior cruciate ligament reconstruction in chronic injuries using ipsilateral Bone-patella tendon-Bone graft in nine patients, between January 2000 and January 2003 at our institution. Methods: Eight male and one female patient; their ages ranged from 18 to 36 years old. The surgery was done at an average of 17.2 months (range from 3 and 40 months) post injury. All patients were followed up for a minimum of two years period. The assessment was done at twelve and twenty-four months using Lysholm knee score, IKDC knee examination evaluation score and arthrometric measurement with KT-2000. Results: The result showed only moderate success in restoration of ligament stability with 73.4% satisfactory objective results. However, the functional improvement and patient satisfaction is only 55%. The incidences of degenerative changes were 89% at the time of operation. Conclusion: Surgical reconstruction of chronic Posterior Cruciate Ligament restored satisfactory stability of the knee but the functional outcome was only moderate.

Commentary on: "Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature".

Spinal stenosis is a problem that spine surgeons deal with commonly, and yet, as the authors pointed out, it is uncommon for patients to present with more than one symptomatic region. When they do, the stenosis tends to occur in the cervical and lumbar region. This would be related to the higher incidence of degenerative changes in the cervical and lumbar spine.1 Clinical symptomatology and signs are most important to help us suspect and differentiate between single-region versus multiregional involvement. For example, in patients presenting with numbness and spasticity in all four limbs but disproportionately severe lower limb symptoms and signs, then tandem cervical and thoracic compressions should be suspected, and a thoracic magnetic resonance imaging should be obtained. Concomitant lumbar and thoracic/cervical stenosis is more difficult to diagnose clinically because it likely includes a mixture of signs. Because of the lumbar compression, the upper motor neuron signs in the lower limbs are likely abated. In such situations, the history maybe more useful if the patient complains of sciatic pain or lower limb claudication. However, it should be borne in mind that if the myelopathy is severe, the patient may not be able to walk sufficiently long distances to lead to claudication. The nature of the pathology may provide clues to the need to screen the spine for additional lesions. In patients with ossified yellow ligament presenting in one region of the spine, it is our practice to screen the other regions, because of the incidence of asymptomatic but critical stenosis in other parts of the spine.2 On the other hand, we know that degenerative changes in the lumbar spine are common as we age and that >90% of the population above the age of 50 will have some degree of lumbar degeneration.3 Thus it is certainly possible that the findings are incidental and not a cause of symptoms. Thus, clinical judgment taking into account clinical exam findings and radiologic findings is key. Patients should not be treated based on only radiologic findings of stenosis. The treatment plan will need to be individualized based on the patient's fitness as well as the nature of the pathology in each region. If the patient is unfit for prolonged surgery, then staged surgery should be performed. In this particular case report, it could be argued that anterior decompression for the cervical lesion could achieve the same result without the need for a long posterior fusion, and if so, it may be better to stage the surgery. Staging also has the advantage of observing the patient postsurgery, and if there is significant recovery, the need for surgery to the other regions may be avoided. Overall, managing such patients requires care in clinical judgment and taking into account the patient's general condition and fitness for concomitant multiple procedures. Generalized recommendations cannot and should not be made. The authors and editors are to be congratulated for highlighting this case for discussion.

Correlation of magnetic resonance imaging findings in low back pain patients with daily travel time and mode

Background: Low back pain (LBP) is the major worldwide cause of pain and it is caused mainly due to long day sedentary work style in office and long hours of travelling in metro cities. The aim was to correlate the association of LBP with increase in time of travel and different modes of travel in metro cities.Methods: Of all the LBP patients referred from orthopedic outpatient department to Radiology Department for magnetic resonance imaging (MRI) spine, 200 cases of those who travelled minimum 2 h daily and more were considered for this study.Results: The results showed correlation of increase in incidence of degenerative changes in spine and changes in disc with increase in travelling time and also the different modes of travel. The changes increased with time significantly in younger population.Conclusions: In our study of 200 patients complaining of LBP and having changes is spine reported on MRI showed reliable association of the LBP to the daily travelling of minimum 2 h and more, and associated with mode of travel, particularly two wheelers followed by public transport.

Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis.

To investigate whether congenital lumbar spinal stenosis (CLSS) is associated with a specific degenerative changes of the lumbar spine. The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl's nodes, spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, disc herniations and spondylolisthesis (P < 0.05). CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine.

Degenerative Changes in Rat Condylar Cartilage Induced by Non-Matching Occlusion Created by Scattered Orthodontic Teeth-Moving

The effect of occlusion on the temporomandibular joint (TMJ) is debated. By inserting rubber-bands that were replaced by self-curing resin one week later, the left maxillary and the right mandibular first-molars were moved and kept mesially in Sprague-Dawley (SD) rats in both experimental I (EXP-I) and II (EXP-II) groups, aiming to establish a non-matching cusp-to-fossa occlusal relation. Four weeks later, the left maxillary and the right mandibular third-molars were moved and kept distally in the EXP-II group. Degenerative changes, typically as a cell-free area, were observed in TMJs of the EXP groups. Binary logistical analysis indicated that the odds ratio of EXP group, EXP-II vs. EXP-I, on the incidence of a cell-free area, was 2.8 (p=.036). Time point, gender, and side did not have such effects (p>0.05). The results indicate that the persistence of more scattered non-matching cusp-to-fossa occlusion is more harmful to the condylar cartilage in terms of the incidence of degenerative changes.

Atraumatiske skulderlidelser

Shoulder pain (usually non-traumatic) is the third most common cause of consultations for musculoskeletal pain in primary health care. This article discusses challenges within diagnostics and treatment of non-traumatic shoulder pain. The article is based on literature identified through a non-systematic search in PubMed and the Cochrane library. One clinical test alone is generally not sufficient to make a pathoanatomical diagnosis. The incidence of degenerative changes in the normal population makes it difficult to interpret diagnostic images. MR is mainly indicated as part of a preoperative assessment and upon a specific indication. For diagnosis of the rotator cuff, ultrasound is as good as MR. Clinical studies do not show clear effects of specific treatment. This may be caused by methodological weaknesses of the trials evaluated and that patient characteristics and placebo effects contribute to the diagnosis. Injection with glucocorticoids seems to be well founded in patients with adhesive capsulate (frozen shoulder). With subacromial pain, supervised physical exercise and surgical treatment have similar effects, but there is not sufficient evidence to recommend particular treatments for rupture. Non-traumatic shoulder pain is usually diagnosed adequately from the medical history and a combination of clinical tests; conservative treatment is most often adequate. When diagnostic imaging is required, ultrasound should be the first choice.

Sprunggelenkchondrozyten besitzen eine höhere Interleukin-1-Resistenz als Kniegelenkchondrozyten

The incidence of degenerative changes and osteoarthritis is lower in the ankle than in the knee joints. This cannot be explained exclusively with differences in anatomy and biomechanical properties of these two synovial joints. Previous studies have indicated distinct differences in the biochemical composition of the extracellular matrix of articular cartilage from knee and ankle joints. The aim of this study was to identify potential metabolic differences between knee and ankle joint chondrocytes using isolated cells to distinguish the secondary effects of the resident extracellular matrix from the primary matrix-independent effects of cellular differentiation. Isolated knee and ankle chondrocytes from the same human donor were cultured in alginate beads and subsequently exposed to a three-day pulse of the catabolic cytokine interleukin-1 (IL-1) as a model of an inflammatory episode. The metabolism of proteoglycans (PG's) was analyzed as expressed changes in 35S-sulfate incorporation into glycosaminoglycans (GAG's). The presence of IL-1 induced an inhibition of PG synthesis in knee and ankle articular chondrocytes. The 50% inhibitory concentration (IC50) of IL-1 was about 5 times lower for knee than for ankle chondrocytes. Ankle chondrocytes are more resistant to IL-1 induced inhibition of PG synthesis than chondrocytes from the knee.

Effect of estrogen on the expression of occludin in ovariectomized mouse brain

The blood–brain barrier (BBB) and blood–cerebrospinal fluid barrier (BCSFB), formed by interactions of tight junctions (TJs) in the endothelia or the choroids plexus, respectively, are important diffusion barriers between systemic circulation and neural tissue of the central nervous system (CNS). Epidemiological incidence of degenerative changes in the CNS is significantly higher in postmenopausal women than in men, suggesting an important role of ovarian steroids for CNS integrity in women. To elucidate the role estrogen in the maintenance of paracellular diffusion barriers in the CNS, changes in the expression of occludin, a TJ protein, following ovariectomy (OVX), as well as the effect of estrogen on the expression of occludin in OVX female brain, were examined in mice. Immunoreactivity of occludin was found in brain endothelial capillaries, choroids plexus, ependyma, and aqueduct. In OVX brain, expression of occludin mRNA and protein was decreased a little but significantly relative to a sham control brain at the estrous stage. Estrogen (17β estradiol) significantly up-regulated occludin mRNA levels in OVX mice. Together, these results suggest that occludin is an important structural element in both the BBB and BCSFB, and that expression of occludin in female brain tissue is sensitive to estrogen levels.

Appearance and incidence of sacroiliac joint disease in ventrodorsal radiographs of the canine pelvis.

Ventrodorsal (VD) radiographs of cadaveric pelves of large and giant breeds (n = 40) and of the corresponding bone specimens were made. Gross changes seen in the specimens were marked with metal wire or radiopaque paint to relate radiographic changes to the postmortem appearance of degenerative sacroiliac (SI) joint lesions. Two positioning techniques were used, resulting in two radiographs for each specimen. The techniques used were: (1) pulling the pelvic limbs caudally, with gentle traction producing a view of the sacrum in almost parallel alignment between the sacrum and the X-ray film (we have termed this a "central SI view") and (2) pulling the pelvic limbs caudally with greater traction than above, resulting in maximal inclination of the sacrum with respect to the X-ray film (we have termed this an "angled SI view"). Lesions of the supportive soft connective tissue could be imaged on the central and angled SI views, whereas angled SI views allowed better identification of lesions of the synovial SI joint. The insights gained in the above study were then used in a retrospective examination of 145 routine ventrodorsal radiographs of the pelvis (i.e., 290 sacroiliac joints) to determine the incidence of degenerative changes of the SI joint in large dogs. The lesions most commonly observed were calcification of the supportive soft connective tissue (n = 184/290), whereas lesions of the synovial SI joint were less frequent (n = 86/290). The degree of central or angled projection obtained in standard ventrodorsal radiographs was noted to be significantly (P < 0.05) associated with age, body conformation, anesthetic status, and the presence of spondylosis deformans at the lumbosacral junction. In contrast, SI joint disease and the gender of the animal did not affect the SI view achieved in VD radiographs.

Scaphoid anatomy and mechanics: Update and review

This review has been an attempt to collate previous research on scaphoid anatomy, load mechanics and kinematics into one article so that the reader can assimilate the information in a convenient way. The scaphoid is a unique carpal bone in shape and function. It has a three-dimensionally oblique orientation and performs a unique function as a mechanical link between the distal and proximal carpal rows on the radial aspect. The load mechanics of the scaphoid play an important role in wrist function and kinematics. Studies of the normal biomechanics of the proximal wrist joint have determined that the scaphoid and lunate bones have separate, distinct areas of contact on the distal radius surface. Kinematics of the scaphoid can be viewed either from proximal or distal. From a proximal view, during radial/ulnar deviation of the wrist, the scaphoid exhibits both a flexion/extension and radial/ulnar deviation motion. Distally, kinematic studies revealed that the scaphoid-trapezoid motion during wrist extension is the same as in wrist radial deviation and the scaphoid-trapezoid motion in wrist flexion is the same as in wrist ulnar deviation. Knowledge of the anatomy of the dorsal carpal ligaments has also provided a wealth of information on their role in carpal motion. The lateral V construct of the DRC (Dorsal Radiocarpal), DIC (Dorsal Intercarpal), and dorsal component of the SLIO (Scapho-lunate interosseous) ligament delivers indirect dorsal stability, yet allows relative free motion of the scaphoid. Injuries that involve the scaphoid can be ligamentous or can involve fracture of the scaphoid with or without ligamentous injury. Because of its complex anatomy, treating scaphoid fractures and nonunions can be challenging and difficult to detect true displacement patterns from plain X-ray films due to the overlapping of the other carpal bones. Degenerative arthritis of the STT (scapho-trapezium-trapezoid) joint is the second most common site of degenerative changes in the wrist. Plain radiographs can be used to measure TT (trapezium-trapezoid) inclination, which has been shown to be correlated with degenerative changes in the STT joint. Research in our lab has demonstrated that wrists with a higher TT inclination had a higher incidence of degenerative changes. This new perspective taking into account anatomy, mechanics and kinematics begins to offer a more global view of how form and function are related and what part the scaphoid plays in carpal function and stability.

Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear

Purpose: To evaluate the clinical outcome and correlate the results and degenerative change of the affected knees with the duration of injury, ligament laxity and follow-up time in 30 patients with 31 knees undergoing arthroscopic single bundle reconstruction for complete posterior cruciate ligament (PCL) tear with 2–9-year follow-up. Materials and methods: This series included 22 men and 8 women with an average age of 32 years. High-energy trauma accounts for 93.5% of PCL injury, while only 6.5% are sports related. Arthroscopic single bundle PCL reconstruction was performed in all knees. The average follow-up time was 40 (range: 24–108) months. The methods of evaluation included functional assessment, ligament laxity and radiograph of the knee. Results: The overall clinical results showed 77.4% satisfactory (61.3% excellent and 16.1% good) and 22.6% unsatisfactory (16.1% fair and 6.5% poor). Complete restoration of ligament stability was noted in 52% of the knees with one third showing mild (0–5 mm) and 9.7% moderate (5–10 mm) ligament laxity. The incidence of radiographic degenerative changes was 52% (16/31), and it correlated with the duration of injury, severity of ligament laxity and length of follow-up time. Conclusion: Arthroscopic single bundle reconstruction produced 77.4% satisfactory clinical results in medium term follow-up. Despite good clinical results, complete restoration of ligament stability was achieved in only 52% of the knees. The incidence of degenerative changes of the affected knees was 52% that correlated with the duration of injury, ligament laxity and follow-up time.

Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee

Purpose: To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2–5-year follow-up. Materials and methods: This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2–24) months, and the average follow-up time was 40 (range 32–60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time. Results: The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5–10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time. Conclusion: Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.

Degenerative spondyloarthropathy of the cervical and lumbar spine in jockeys.

This prospective study analyzed the long-term effects of horse riding on the cervical and lumbar spine of jockeys. Thirty-two jockeys were observed for 13 years. All jockeys had clinical and radiographic evaluation of the spine; three consecutive age groups were studied. Results were compared to age-matched, normal population control groups. The incidence of degenerative changes of the spine was higher in the jockeys compared with the control groups and was more prominent in the older age group for both the lumbar and cervical spine. These findings suggest that equestrian sports, particularly professional horse riding, apart from the increased risk of direct spinal injury caused by a fall from the horse, can lead to progressive spine degeneration as a result of repetitive trauma and increased physical stress on the spine.

Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage

We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years. According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p &lt; 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome. Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score.

Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage.

We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years. According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p < 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome. Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score.

The natural history of the anterior cruciate ligament-deficient knee. Changes in synovial fluid cytokine and keratan sulfate concentrations.

Restoring knee stability through reconstruction, while providing symptomatic relief, has not been shown to decrease the incidence of degenerative changes after rupture of the anterior cruciate ligament. This suggests that posttraumatic osteoarthritis may not be purely biomechanical in origin, but also biochemical. To test this, we measured the levels of seven cytokine modulators of cartilage metabolism in knee joint synovial fluid after anterior cruciate ligament rupture. We also measured keratan sulfate, a product of articular cartilage catabolism. The sample population consisted of patients with uninjured knee joints (N = 10), and patients with acute (N = 60), subacute (N = 18), and chronic (N = 8) anterior cruciate ligament-deficient knees. Synovial fluid samples were analyzed by enzyme-linked immunosorbent assays. Normal synovial fluids contained high levels of the interleukin-1 receptor antagonist but low concentrations of other cytokines. Immediately after ligament rupture there were large increases in interleukins 6 and 8, tumor necrosis factor alpha, and keratan sulfate. Interleukin-1 levels remained low throughout the course. As the injury became subacute and then chronic, interleukin-6, tumor necrosis factor-alpha, and keratan sulfate levels fell but remained considerably elevated 3 months after injury. Concentrations of interleukin-1Ra fell dramatically. Granulocyte-macrophage colony-stimulating factor concentrations were normal acutely and subacutely but by 3 months after injury were elevated 10-fold. Our data reveal a persistent and evolving disturbance in cytokine and keratan sulfate profiles within the anterior cruciate ligament-deficient knee, suggesting an important biochemical dimension to the development of osteoarthritis there.

Synovial fluid cytokine concentrations as possible prognostic indicators in the ACL-deficient knee.

Approximately 44% of patients develop osteoarthritis (OA) following rupture of the anterior cruciate ligament (ACL) if the injury is left unrepaired. Restoring knee stability through reconstruction, while providing symptomatic relief, has not been shown to reduce the incidence of degenerative changes. In fact, recent studies have shown that 50%-60% of ACL-reconstructed patients go on to develop degenerative changes or frank osteoarthritis. In light of these data, our group suggests that the cause of post-traumatic osteoarthritis is not biomechanical but biochemical. To test this hypothesis, we measured levels of nine cytokines which are important in modulating physiological and pathophysiological metabolism of cartilage in knee joint synovial fluid following ACL rupture. Our patient population contained both acute and chronic ACL ruptures. A total of 84 samples were collected and analyzed by enzyme-linked immunosorbent assay. On the basis of the data collected, we were able to identify subgroups of patients who, on the basis of their synovial fluid cytokine profile, may be at greater or lesser risk of developing post-traumatic OA. In general, patients displayed concentrations of interleukin-1 alpha (IL-1 alpha), basic fibroblastic growth factor (bFGF), transforming growth factor-beta (TGF-beta), granulocyte/macrophage-colony stimulating factor (GM-CSF), IL-6, and IL-8 that we interpreted as being consistent with an inflammatory reaction. Of great interest is the fact that the levels of these cytokines were very similar in patients 4 weeks after injury and in chronic patients, leading us to hypothesize that a chronic smoldering inflammatory reaction persists after resolution of the acute effusion.(ABSTRACT TRUNCATED AT 250 WORDS)