Background: Synovial fluid (SF) biomarkers demonstrate time-dependent variation after acute knee injury, and it is postulated that persistently elevated inflammatory markers may mediate worse long-term outcomes. Purpose: This study investigated the relationship between biomarkers in SF at the time of meniscectomy and long-term patient-reported outcomes in patients with acute versus chronic meniscal injuries. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective analysis included patients who underwent knee SF aspiration on the day of arthroscopic meniscectomy between October 2011 and October 2020 with minimum 4-year follow-up. SF aspirated from the operative knee was analyzed for 10 pro- and anti-inflammatory biomarkers. Patients completed the visual analog scale for pain, Lysholm Knee Questionnaire, Tegner Activity Scale, and Knee injury and Osteoarthritis Outcome Score–Physical Function Short-form (KOOS-PS) before surgery and at follow-up. Patients were categorized as having acute (<6 weeks) or chronic (>1 year) symptoms. K-means clustering analysis was performed using biomarker levels to group patients into distinct cohorts. Results: Of 85 patients meeting inclusion criteria, 55 had chronic and 30 had acute meniscal pathology, with 62 (72.9%) completing patient-reported outcome surveys at a mean follow-up of 8.66 years (SD, 2.27). K-means clustering identified 2 distinct biomarker profiles: a high-inflammation cluster and a low-inflammation cluster. The high-inflammation cluster had higher levels of 7 proinflammatory biomarkers as compared with the low-inflammation cluster ( P = .015). The low-inflammation cluster predominantly comprised chronic meniscal injuries (89.2%), whereas the high-inflammation cluster was divided between acute and chronic cases. There were no differences in postoperative outcomes between clusters in the overall cohort. However, within the chronic cohort, the high-inflammation cluster exhibited worse postoperative scores on the visual analog scale for pain ( P = .035), Lysholm questionnaire ( P = .007), KOOS-PS ( P = .038), and Tegner scale ( P = .049) and had a higher rate of postoperative injections ( P = .020) than the low-inflammation cohort. Conclusion: In patients with chronic meniscal injury, those with a more proinflammatory SF biomarker profile at the time of meniscectomy had worse outcomes than those who had a low inflammatory profile. In acute meniscal injuries, most patients demonstrate a high inflammatory profile, which was not associated with a difference in long-term outcomes.

中文翻译：

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促炎性滑液生物标志物可预测慢性半月板损伤的不良长期结局

背景： 滑液 （SF） 生物标志物在急性膝关节损伤后表现出时间依赖性变化，据推测，持续升高的炎症标志物可能会介导更差的长期结果。目的： 本研究调查了半月板切除术时 SF 生物标志物与急性与慢性半月板损伤患者长期患者报告结局之间的关系。研究设计：队列研究;证据水平，3.方法： 本回顾性分析包括 2011 年 10 月至 2020 年 10 月在关节镜半月板切除术当天接受膝关节 SF 抽吸且至少随访 4 年的患者。分析从手术膝关节抽吸的 SF 的 10 种促炎和抗炎生物标志物。患者在手术前和随访前完成了疼痛视觉模拟量表、Lysholm 膝关节问卷、Tegner 活动量表和膝关节损伤和骨关节炎结果评分-身体功能简表 （KOOS-PS）。患者分为急性 （<6 周） 或慢性 （>1 岁） 症状。使用生物标志物水平进行 K-means 聚类分析，将患者分为不同的队列。结果： 在符合纳入标准的 85 例患者中，55 例为慢性，30 例为急性半月板病变，其中 62 例 （72.9%） 在平均随访 8.66 年 （SD，2.27） 时完成了患者报告的结果调查。K-means 聚类确定了 2 个不同的生物标志物特征：高炎症簇和低炎症簇。 与低炎症簇相比，高炎症簇具有更高水平的 7 种促炎生物标志物 （P = .015）。低炎症集群主要包括慢性半月板损伤 （89.2%），而高炎症集群分为急性和慢性病例。整个队列中各集群之间的术后结局没有差异。然而，在慢性队列中，高炎症组在疼痛视觉模拟量表 （P = .035）、Lysholm 问卷 （P = .007）、KOOS-PS （P = .038） 和 Tegner 量表 （P = .049） 上表现出较差的术后评分，并且术后注射率 （P = .020） 高于低炎症队列。结论： 在慢性半月板损伤患者中，半月板切除术时促炎性 SF 生物标志物特征较高的患者比炎症性低的患者预后更差。在急性半月板损伤中，大多数患者表现出高度炎症特征，这与长期结果的差异无关。