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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关节镜部分半月板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为全膝关节置换术：一项 10 年平均随访研究。


背景本研究的目的是评估关节镜部分半月板切除术（APM）时膝关节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）和转为全膝关节置换术（TKA）。方法 对因孤立性半月板损伤而接受 APM 的患者数据库进行分析。在手术切口前从手术治疗的膝关节中吸出滑液，并测量促炎和抗炎生物标志物的浓度（RANTES、IL-6、MCP-1、MIP-1β、VEGF、TIMP-1、TIMP-2） 、IL-1RA、MMP-3 和 bFGF）进行了定量。在手术前和最终随访时，患者被要求完成一项调查，其中包括疼痛和 Lysholm、Tegner 和膝损伤的视觉模拟量表 (VAS) 以及骨关节炎结果评分 - 身体功能简表（ KOOS-PS）问卷。使用 k 均值算法对 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，59 名患者中的 43 名（73%）在长期随访中填写了 PRO 问卷。平均随访时间为 10.6 ± 1.3 年（范围为 8.7 至 12.4 年）。较高浓度的个体促炎生物标志物，包括 MCP-1（β = 13.672，p = 0.017）和 MIP-1β（β = -0.385，p = 0.012）分别与较差的 VAS 疼痛和 Tegner 评分相关。 K 均值聚类分析将 82 名患者分为两组，其中一组的促炎生物标志物水平明显高于第二组。 “促炎表型”队列的 VAS 疼痛评分显着较高（p = 0.024），并且与“抗炎表型”队列相比，最终随访时 Lysholm（p = 0.022）、KOOS-PS（p = 0.047）和 Tegner（p = 0.009）评分显着降低。促炎队列中转为 TKA 的比率较高（29.4% 对比 12.2%，p = 0.064）。 Logistic 回归分析表明，促炎表型与转为 TKA 显着相关（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组和抗炎组，这些组可预测长期随访中的 PRO 和转为 TKA。证据级别 预后 III 级。有关证据级别的完整描述，请参阅作者须知。