遗传、性别和富血小板血浆的使用会影响前十字韧带重建术后关节纤维化的发展。

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-01-28 DOI:10.1002/jeo2.70156

Mikel Sánchez, Izarbe Yarza, Cristina Jorquera, Jose María Aznar, Leonor López de Dicastillo, Cristina Valente, Renato Andrade, João Espregueira-Mendes, David Celorrio, Beatriz Aizpurua, Juan Azofra, Diego Delgado

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引用次数: 0

摘要

目的：探讨前交叉韧带（ACL）重建后患者发生关节纤维化的相关基因和患者因素，并建立预后模型。方法：本研究纳入诊断为前交叉韧带损伤并行前交叉韧带重建的患者。患者连续入组，分为非纤维化组（对照组）和纤维化组（病例组），直到达到匹配病例对照的平衡样本。如果术后3个月的活动范围比最初的全活动范围减少至少25%，则认为关节纤维化是病理性的。从每位患者收集患者变量和唾液样本，通过筛选一组与关节纤维化有关的候选基因来执行遗传方法。采用卡方分析关节纤维化的发生与不同自变量之间的关系。二元逻辑回归用于发展一种预测算法。结果：共纳入对照组（非纤维化患者）45例（50.1%）和纤维化患者44例（49.9%）进行分析。中位年龄为34.0岁（95%可信区间为29.0 ~ 38.0），女性32例（35.9%）。7个遗传多态性与关节纤维化的发生有显著相关性（p p）结论：参与炎症和细胞外基质转换的遗传改变易导致前交叉韧带重建后关节纤维化的发生。女性是该疾病发生的危险因素，而PRP的应用提供了预防效果。患者和患者基因变异的结合使得术后关节纤维化风险的预后算法得以发展。证据等级：三级。

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Genetics, sex and the use of platelet-rich plasma influence the development of arthrofibrosis after anterior cruciate ligament reconstruction

Purpose

To identify genes and patient factors that are related to the development of arthrofibrosis in patients after anterior cruciate ligament (ACL) reconstruction and to develop a prognostic model.

Methods

The study included patients diagnosed with ACL injury who underwent ACL reconstruction. Patients were enroled consecutively and divided into non-fibrotic (controls) and fibrotic (cases) groups until a balanced sample of matched case–control was achieved. Arthrofibrosis was considered pathological if the range of motion achieved 3 months after surgery decreased by at least 25% compared to its initial full range of motion. Patient variables and saliva samples were collected from each patient to perform a genetic approach by screening a set of candidate genes implicated in arthrofibrosis. Chi-squared was used to analyze the association between the development of arthrofibrosis and different independent variables. Binary logistic regression was used to develop a prognostic algorithm.

Results

A total of 45 controls (non-fibrotic patients) (50.1%) and 44 cases (fibrotic patients) (49.9%) were included for analysis. The median age was 34.0 years (95% confidence interval = 29.0–38.0) and the number of women was 32 (35.9%). Seven genetic polymorphisms showed significant association with the development of arthrofibrosis (p < 0.05). After binary regression analysis, the regression model included the polymorphisms rs4343 (ACE), rs1800947 (CRP), rs8032158 (NEDD4) and rs679620 (MMP3). This analysis also indicated that female gender was a risk factor while the use of platelet-rich plasma (PRP) during surgery was a preventive factor (p < 0.05).

Conclusion

Genetic alterations involved in inflammation and extracellular matrix turnover predispose to the development of arthrofibrosis after ACL reconstruction. Female sex was a risk factor in the development of this condition, while the application of PRP provided a preventive effect. The combination of patient and genetic variants of a patient allows the development of a prognostic algorithm for the risk of post-surgical arthrofibrosis.