Background: It is increasingly recognized that biochemical abnormalities of the joint precede radiographic abnormalities of post traumatic osteoarthritis (PTOA) by as much as decades. A growing body of evidence strongly suggests that the progression from anterior cruciate ligament (ACL) injury to PTOA is multifactorial, involving the interplay between biomechanical disturbances and biochemical homeostasis of articular cartilage.
Purpose: A randomized study using an acute ACL injury model were to (1) evaluate the natural progression of inflammatory and chondro-degenerative biomarkers, (2) evaluate the relationship between subjective reports of pain and inflammatory and chondro-degenerative biomarkers, and (3) determine if post injury knee drainage (arthrocentesis) and corticosteroid injection offer the ability to alter this biochemical cascade.
Study Design: Randomized controlled trial.
Methods: A total of 49 patients were randomized to 4 groups: group 1 (corticosteroid at 4 days after ACL injury, placebo injection of saline at 2 weeks), group 2 (placebo at 4 days after ACL injury, corticosteroid at 2 weeks), group 3 (corticosteroid at both time intervals), or a placebo group (saline injections at both time intervals). Patient-reported outcome measures and synovial biomarkers were collected at approximately 4 days, 11 days, and 5 weeks after injury. The change between the time points was assessed for all variables using statistical analysis, and the relationship between changes in outcome scores and biomarkers were assessed by calculating a commonly accepted mathematical analysis. Outcomes and biomarkers were also compared between the 4 groups using another statistical approach.
Results: No adverse events or infections were observed in any study patients. With the exception of matrix metalloproteinase 1 (MMP-1) and tumor necrosis factor–inducible gene 6 (TSG-6), chondro-degenerative markers worsened over the first 5 weeks while all patient-reported outcomes improved during this time, regardless of treatment group. Patient-reported outcomes did not differ between patients receiving corticosteroid injections and the placebo group. However, increases in C-telopeptide of type II collagen (CTX-II), associated with collagen type II breakdown, were significantly greater in the placebo group (1.32 ± 1.10 ng/mL) than in either of the groups that received the corticosteroid injection within the first several days after injury (group 1: 0.23 ± 0.27 ng/mL [P = .01]; group 3: 0.19 ± 0.34 ng/mL [P= .01]).
Conclusion: Post Traumatic Osteoarthritis begins at the time of injury and results early on in dramatic matrix changes in the knee. However, it is encouraging that early intervention with an anti-inflammatory agent was able to affect biomarkers of chondral degeneration. Should early intervention lead to meaningful changes in either the onset or severity of symptomatic PTOA, the current treatment paradigm for patients with ACL injury may have to be restructured to include early aspiration and intra-articular intervention.
This Blog is excerpted from a study appearing in the American Journal of Sports Medicine. My message, should you experience a significant joint injury, don’t wait until arthritic related symptoms appear, the Cellular Orthopedic intervention should take place within weeks; not years.
312-475-4523 to learn more or schedule an appointment
Tags: ACL Injury, ACL tear, arthritis, athletes, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, corticosteriod injection, Interventional Orthopedics, Knee, knee injury, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon