title: Prospective clinical trial of patients who underwent ankle arthroscopy with articular diseases to match clinical and radiological scores with intra-articular cytokines.
abstract: OBJECTIVE
  There is still a lack of reliable data on cytokine concentrations in the ankle and their value for prognosis.
  
  
  METHODS
  In a prospective clinical trial, lavage fluids were collected from 49 patients with an arthroscopy of the ankle. The fluids were investigated by ELISA for cytokine levels. Clinical scores (FFI, AOFAS) were evaluated both pre-operatively and then again 12 months after surgery (n = 43, 88%). Radiological changes were noted with the Kellgren-Lawrence-Score (KLS) and the Ankle Osteoarthritis Scoring System (AOSS). Based on the difference between the pre- and postoperative clinical scores, two groups were defined according to whether they had benefited from the surgical therapy (Δ score ≥ 10) or not (Δ score < 10).
  
  
  RESULTS
  The average clinical scores had improved to a statistically significant extent in the one-year follow-up (p < 0.01). BMP-2 (p = 0.02), IGF-1 (p = 0.04), BMP-7 (p = 0.01) and aggrecan (p = 0.04) showed significant correlations with pre-operative clinical and radiological scores (p = 0.02, p = 0.01, p = 0.01, p = 0.01). Furthermore, BMP-2 (p = 0.01), IGF-1/TPC (p = 0.03) and aggrecan (p = 0.01) correlated with scores after one year (p = 0.02, p = 0.01). High aggrecan concentrations were associated with a low clinical and a high radiological score at both time points, both indicating progress of cartilage degeneration in contrast to BMP-2 or IGF-1. Furthermore, MMP-13 concentrations were significantly higher in the non-benefit group (p = 0.02).
  
  
  CONCLUSIONS
  BMP-2, IGF-1, aggrecan and MMP-13 seem to be involved in the degenerative process of cartilage in the ankle joint. Additionally, high synovial MMP-13 concentrations indicate a worse clinical outcome.
authors.affiliation: Clinic of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany, ralfhenkelmann@googlemail.com.
authors.forename: Ralf
authors.initials: R
authors.lastname: Henkelmann
authors.forename: Hagen
authors.initials: H
authors.lastname: Schmal
authors.forename: Ingo H
authors.initials: IH
authors.lastname: Pilz
authors.forename: Gian M
authors.initials: GM
authors.lastname: Salzmann
authors.forename: David
authors.initials: D
authors.lastname: Dovi-Akue
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053674:Aggrecans / Q000378:metabolism; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy; D055396:Bone Morphogenetic Protein 2 / Q000378:metabolism; D002358:Cartilage, Articular / Q000378:metabolism; D002648:Child; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D053509:Matrix Metalloproteinase 13 / Q000378:metabolism; D008875:Middle Aged; D010008:Osteochondritis Dissecans; D011446:Prospective Studies; D011859:Radiography; D013582:Synovial Fluid / Q000378:metabolism; D055815:Young Adult
chemical_list: D053674:Aggrecans; C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D016207:Cytokines; D053509:Matrix Metalloproteinase 13