BACKGROUND The purpose of the present study was to evaluate the relationships of the concentrations of pro- and anti-inflammatory biomarkers in the knee synovial fluid at the time of arthroscopic partial meniscectomy (APM) to long-term patient-reported outcomes (PROs) and conversion to total knee arthroplasty (TKA). METHODS A database of patients who underwent APM for isolated meniscal injury was analyzed. Synovial fluid had been aspirated from the operatively treated knee prior to the surgical incision, and concentrations of pro- and anti-inflammatory biomarkers (RANTES, IL-6, MCP-1, MIP-1β, VEGF, TIMP-1, TIMP-2, IL-1RA, MMP-3, and bFGF) were quantified. Prior to surgery and again at the time of final follow-up, patients were asked to complete a survey that included a visual analog scale (VAS) for pain and Lysholm, Tegner, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) questionnaires. Clustering analysis of the 10 biomarkers of interest was carried out with the k-means algorithm. RESULTS Of the 82 patients who met the inclusion criteria for the study, 59 had not undergone subsequent ipsilateral TKA or APM, and 43 (73%) of the 59 completed PRO questionnaires at long-term follow-up. The mean follow-up time was 10.6 ± 1.3 years (range, 8.7 to 12.4 years). Higher concentrations of individual pro-inflammatory biomarkers including MCP-1 (β = 13.672, p = 0.017) and MIP-1β (β = -0.385, p = 0.012) were associated with worse VAS pain and Tegner scores, respectively. K-means clustering analysis separated the cohort of 82 patients into 2 groups, one with exclusively higher levels of pro-inflammatory biomarkers than the second group. The "pro-inflammatory phenotype" cohort had a significantly higher VAS pain score (p = 0.024) and significantly lower Lysholm (p = 0.022), KOOS-PS (p = 0.047), and Tegner (p = 0.009) scores at the time of final follow-up compared with the "anti-inflammatory phenotype" cohort. The rate of conversion to TKA was higher in the pro-inflammatory cohort (29.4% versus 12.2%, p = 0.064). Logistic regression analysis demonstrated that the pro-inflammatory phenotype was significantly correlated with conversion to TKA (odds ratio = 7.220, 95% confidence interval = 1.028 to 50.720, p = 0.047). CONCLUSIONS The concentrations of synovial fluid biomarkers on the day of APM can be used to cluster patients into pro- and anti-inflammatory cohorts that are predictive of PROs and conversion to TKA at long-term follow-up. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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关节镜下半月板部分切除术当天滑液炎症生物标志物的水平可预测长期结果和转化为 TKA：一项 10 年平均随访研究。


背景 本研究的目的是评估关节镜下半月板部分切除术 （APM） 时膝滑液中促炎和抗炎生物标志物浓度与长期患者报告结果 （PRO） 和转化为全膝关节置换术 （TKA） 的关系。方法 分析了因孤立性半月板损伤而接受 APM 的患者数据库。手术切口前从手术治疗的膝关节抽吸滑液，并量化促炎和抗炎生物标志物 （RANTES 、 IL-6 、 MCP-1 、 MIP-1β 、 VEGF 、 TIMP-1 、 TIMP-2 、 IL-1RA 、 MMP-3 和 bFGF ）的浓度。在手术前和最终随访时，要求患者完成一项调查，其中包括疼痛视觉模拟量表 （VAS） 以及 Lysholm、Tegner 和膝关节损伤和骨关节炎结果评分-身体功能简表 （KOOS-PS） 问卷。使用 k-means 算法对 10 个感兴趣的生物标志物进行聚类分析。结果 在符合研究纳入标准的 82 名患者中，59 名未接受后续同侧 TKA 或 APM，43 名患者中有 73 名 （73%） 在长期随访中完成了 PRO 问卷。平均随访时间为 10.6 ± 1.3 年 （范围，8.7 至 12.4 年）。较高浓度的单个促炎生物标志物，包括 MCP-1 （β = 13.672，p = 0.017） 和 MIP-1β （β = -0.385，p = 0.012） 分别与更差的 VAS 疼痛和 Tegner 评分相关。K-means 聚类分析将 82 名患者的队列分为 2 组，一组的促炎生物标志物水平仅高于第二组。“促炎表型”队列的 VAS 疼痛评分显着更高 （p = 0.024） 和最终随访时 Lysholm （p = 0.022） 、KOOS-PS （p = 0.047） 和 Tegner （p = 0.009） 评分与“抗炎表型”队列相比。在促炎队列中，转化为 TKA 的比率较高 （29.4% 对 12.2%，p = 0.064）。Logistic 回归分析表明，促炎表型与转化为 TKA 显著相关 （比值比 = 7.220,95% 置信区间 = 1.028 至 50.720，p = 0.047）。结论 APM 当天滑液生物标志物的浓度可用于将患者分为促炎和抗炎队列，这些队列可预测 PRO 并在长期随访中转化为 TKA。证据级别 预后 III 级 .有关证据级别的完整描述，请参阅作者说明。