CORRELATION ANALYSIS OF BONE MARROW EDEMA DEGREE AND SERUM INFLAMMATORY FACTORS CHANGE WITH KNEE JOINT PAIN SYMPTOMS IN PATIENTS WITH BONE CONTUSION AROUND THE KNEE JOINT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LISongjun , ANRongze , WANGZhaojie , KUANGLipeng , TANWeiyuan , FANGCunxun

Department of Orthopaedic Surgery, the Fifth Affiliated(Zhuhai) Hospital to Zunyi Medical College, Zhuhai Guangdong, 519100, P. R. China;

Corresponding?author：

LISongjun, Email: lsjfym@163.com

Keywords：

Bone contusion around the knee joint; Bone marrow edema; Matrix metalloproteinase 3; Tumor necrosis factor

DOI：

10.7507/1002-1892.20140137

Video：

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Objective To explore the correlation between the degree of bone marrow edema (BME) and the content change of tumor necrosis factor α (TNF-α) and matrix metalloproteinase 3 (MMP-3) and the knee pain symptoms in patients with bone contusion around the knee joint. Methods Thirty patients (30 knees) of bone contusion around the knee joint were chosen as the trial group between October 2009 and April 2012. According to visual analogue scale (VAS), 30 patients were divided into mild group (10 cases), moderate group (10 cases), and severe group (10 cases); according to MRI morphological changes, the patients were divided into type I group (12 cases), type Ⅱ group (11 cases), and type Ⅲ group (7 cases). Ten patients (10 knees) with soft tissue injury of the knee were chosen as control group. No significant difference was found (P>0.05) in gender, age, causes, side, and admission time after injury between 2 groups. The serum contents of MMP-3 and TNF-α were detected and statistically analysed between different degrees of pain groups and between different degrees of BME groups. Correlation was analysed between BME and inflammatory factor changes and VAS score. Results The MMP-3 and TNF-α contents in trial group[(29.580±6.870) μg/L and (23.750±7.096) ng/L] were significantly higher than those in control group[(8.219±1.355) μg/L and (6.485±1.168) ng/L](t=9.686, P=0.000; t=7.596, P=0.000). The MMP-3 and TNF-α contents in patients with different degrees of pain and BME were significantly higher than those in patients of control group (P<0.05), and significant difference was found between patients with different degrees of pain (P<0.05), but no significant difference between patients with different degrees of BME (P>0.05). Multiple linear regression analysis showed that TNF-α content was significantly correlated with VAS score (P=0.000). Conclusion Knee pain symptoms are not related to the degree of BME in patients with bone contusion around the knee joint. Inflammatory factor TNF-α content is the main influence factor of knee joint pain symptoms.

Citation： LISongjun, ANRongze, WANGZhaojie, KUANGLipeng, TANWeiyuan, FANGCunxun. CORRELATION ANALYSIS OF BONE MARROW EDEMA DEGREE AND SERUM INFLAMMATORY FACTORS CHANGE WITH KNEE JOINT PAIN SYMPTOMS IN PATIENTS WITH BONE CONTUSION AROUND THE KNEE JOINT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 615-619. doi: 10.7507/1002-1892.20140137 Copy

1.	Steinbach LS, Suh KJ. Bone marrow edema pattern around the knee on magnetic resonance imaging excluding acute traumatic lesions. Semin Musculoskelet Radiol, 2011, 15(3):208-220.
2.	王長彬, 孫鋼. 股骨頭缺血壞死與伴有骨髓水腫的一過性骨質疏松的MRI表現及其研究進展. 醫學影像學雜志, 2010, 20(1):132-135.
3.	Bartl C, Imhoff A, Bartl R. Treatment of bone marrow edema syndrome with intravenous ibandronate. Arch Orthop Trauma Surg, 2012, 132(12):1781-1788.
4.	龔沈初, 黃勝, 崔磊, 等. 膝關節骨挫傷的MRI表現和臨床意義. 實用放射學雜志, 2005, 21(12):1300-1302.
5.	張雪哲, 王武. 重視MRI在骨髓病變的臨床應用. 中華放射學雜志, 2001, 35(6):405.
6.	張積春, 石敏琴, 馬彬. 低場磁共振成像檢查在膝關節外傷中的價值分析. 實用醫技雜志, 2013, 20(10):1082-1083.
7.	任秀紅, 劉彥鋒. MRI對骨挫傷的診斷價值. 中國傷殘醫學, 2013, 21(5):47-48.
8.	仇曉巖, 劉廣軍, 王新波, 等. 膝關節隱匿性骨折66例MRI診斷分析. 中國誤診學雜志, 2012, 12(8):1920-1921.
9.	Koo KH, Ahn IO, Kim R, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head:prospective study with serial MR images. Radiology, 1999, 213(3):715-722.
10.	Oda H, Igarashi M, Sase H, et al. Bone bruise in magnetic resonance imaging strongly correlates with the production of joint effusion and with knee osteoarthritis. J Orthop Sci, 2008, 13(1):7-15.
11.	Stone AV, Loeser RF, Vanderman KS, et al. Pro-inflammatory stimulation of meniscus cells increases production of matrix metalloproteinases and additional catabolic factors involved in osteoarthritis pathogenesis. Osteoarthritis Cartilage, 2014, 22(2):264-174.
12.	Lee A, Qiao Y, Grigoriev G, et al. Tumor necrosis factor α induces sustained signaling and a prolonged and unremitting inflammatory response in rheumatoid arthritis synovial fibroblasts. Arthritis Rheum, 2013, 65(4):928-938.
13.	Zhang SL, Liu HQ, Xu XZ, et al. Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis. Mol Med Rep, 2013, 7(1):183-186.
14.	Lee AS, Ellman MB, Yan D, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene, 2013, 527(2):440-447.
15.	Johnson DL, Urban WP Jr, Caborn DN, et al. Articular cartilage changes seen with magnetic resonance imaging detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med, 1998, 26(3):409-414.
16.	Ziskoven C, Jager M, Zilkens C, et al. Oxidative stress in secondary osteoarthritis:from cartilage destruction to clinical presentation. Orthop Rev (Pavia), 2010, 2(2):e23.
17.	Huang MJ, Wang L, Jin DD, et al. Enhancement of the synthesis of n-3 PUFAs in fat-1 transgenic mice inhibits mTORC1 signalling and delays surgically induced osteoarthritis in comparison with wild-type mice. Ann Rheum Dis, 2013.[Epub ahead of print].
18.	Lindenlaub T, Sommer C. Cytokines in sural nerve biopsies from inflammatory and noninflammatory neuropathies. Acta Neuropathol, 2003, 105(6):593-602.
19.	Tolboom TC, Pieterman E, van der Laan WH, et al. Invasive properties of fibroblast-like synoviocytes:correlation with growth characteristics and expression of MMP-1, MMP-3, and MMP-10. Ann Rheum Dis, 2002, 61(11):975-980.
20.	謝國平, 樊粵光, 徐謙, 等. 關節液MMP-3、TIMP-1對膝骨關節炎的臨床價值評價. 按摩與康復醫學, 2013, 4(9):111-112.
21.	朱新輝, 徐大偉, 黃巍, 等. 膝關節骨性關節炎血液和滑液MMP-3水平與其病變程度的相關性. 中國骨質疏松雜志, 2013, 19(3):203-206.

1. Steinbach LS, Suh KJ. Bone marrow edema pattern around the knee on magnetic resonance imaging excluding acute traumatic lesions. Semin Musculoskelet Radiol, 2011, 15(3):208-220.
2. 王長彬, 孫鋼. 股骨頭缺血壞死與伴有骨髓水腫的一過性骨質疏松的MRI表現及其研究進展. 醫學影像學雜志, 2010, 20(1):132-135.
3. Bartl C, Imhoff A, Bartl R. Treatment of bone marrow edema syndrome with intravenous ibandronate. Arch Orthop Trauma Surg, 2012, 132(12):1781-1788.
4. 龔沈初, 黃勝, 崔磊, 等. 膝關節骨挫傷的MRI表現和臨床意義. 實用放射學雜志, 2005, 21(12):1300-1302.
5. 張雪哲, 王武. 重視MRI在骨髓病變的臨床應用. 中華放射學雜志, 2001, 35(6):405.
6. 張積春, 石敏琴, 馬彬. 低場磁共振成像檢查在膝關節外傷中的價值分析. 實用醫技雜志, 2013, 20(10):1082-1083.
7. 任秀紅, 劉彥鋒. MRI對骨挫傷的診斷價值. 中國傷殘醫學, 2013, 21(5):47-48.
8. 仇曉巖, 劉廣軍, 王新波, 等. 膝關節隱匿性骨折66例MRI診斷分析. 中國誤診學雜志, 2012, 12(8):1920-1921.
9. Koo KH, Ahn IO, Kim R, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head:prospective study with serial MR images. Radiology, 1999, 213(3):715-722.
10. Oda H, Igarashi M, Sase H, et al. Bone bruise in magnetic resonance imaging strongly correlates with the production of joint effusion and with knee osteoarthritis. J Orthop Sci, 2008, 13(1):7-15.
11. Stone AV, Loeser RF, Vanderman KS, et al. Pro-inflammatory stimulation of meniscus cells increases production of matrix metalloproteinases and additional catabolic factors involved in osteoarthritis pathogenesis. Osteoarthritis Cartilage, 2014, 22(2):264-174.
12. Lee A, Qiao Y, Grigoriev G, et al. Tumor necrosis factor α induces sustained signaling and a prolonged and unremitting inflammatory response in rheumatoid arthritis synovial fibroblasts. Arthritis Rheum, 2013, 65(4):928-938.
13. Zhang SL, Liu HQ, Xu XZ, et al. Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis. Mol Med Rep, 2013, 7(1):183-186.
14. Lee AS, Ellman MB, Yan D, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene, 2013, 527(2):440-447.
15. Johnson DL, Urban WP Jr, Caborn DN, et al. Articular cartilage changes seen with magnetic resonance imaging detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med, 1998, 26(3):409-414.
16. Ziskoven C, Jager M, Zilkens C, et al. Oxidative stress in secondary osteoarthritis:from cartilage destruction to clinical presentation. Orthop Rev (Pavia), 2010, 2(2):e23.
17. Huang MJ, Wang L, Jin DD, et al. Enhancement of the synthesis of n-3 PUFAs in fat-1 transgenic mice inhibits mTORC1 signalling and delays surgically induced osteoarthritis in comparison with wild-type mice. Ann Rheum Dis, 2013.[Epub ahead of print].
18. Lindenlaub T, Sommer C. Cytokines in sural nerve biopsies from inflammatory and noninflammatory neuropathies. Acta Neuropathol, 2003, 105(6):593-602.
19. Tolboom TC, Pieterman E, van der Laan WH, et al. Invasive properties of fibroblast-like synoviocytes:correlation with growth characteristics and expression of MMP-1, MMP-3, and MMP-10. Ann Rheum Dis, 2002, 61(11):975-980.
20. 謝國平, 樊粵光, 徐謙, 等. 關節液MMP-3、TIMP-1對膝骨關節炎的臨床價值評價. 按摩與康復醫學, 2013, 4(9):111-112.
21. 朱新輝, 徐大偉, 黃巍, 等. 膝關節骨性關節炎血液和滑液MMP-3水平與其病變程度的相關性. 中國骨質疏松雜志, 2013, 19(3):203-206.

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CORRELATION ANALYSIS OF BONE MARROW EDEMA DEGREE AND SERUM INFLAMMATORY FACTORS CHANGE WITH KNEE JOINT PAIN SYMPTOMS IN PATIENTS WITH BONE CONTUSION AROUND THE KNEE JOINT

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