Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Relationship Between Synovitis and Two-Year Post-Surgical Outcomes in Patients Undergoing Arthroscopic Partial meniscectomy.
Scanzello1, Carla R., DiCarlo2, Edward F., Kanda1, Veero, Albert3, Anthony, Goldring2, Steven R., Richmond3, John C., McKeon4, Brian
In established OA, the presence of synovitis is associated with pain and progression of disease. We previously demonstrated that synovitis is also associated with worse pre-operative symptoms in patients undergoing arthroscopic partial meniscectomy, even in the absence of radiographic OA. Synovial inflammation in these patients was associated with expression of CCL19 and CCR7. Despite no radiographically evident disease, the majority (80%) of these patients had intra-operative evidence of early-stage OA. The present study is the longitudinal follow-up of these patients to test whether synovial inflammation predicts progressive knee symptoms up to 2 years post-operatively.
Thirty-three patients undergoing athroscopic partial meniscectomy were recruited from Orthopedic practices at the New England Baptist Hospital. Synovial biopsies were taken at the time of surgery, and inflammation was previously scored on H&E stained sections using our published histologic scale based on the extent of perivascular lymphocytic infiltration. Symptoms were measured by the Lysholm score (a questionnaire measuring knee-specific symptoms and dysfunction) pre-operatively, at 16 weeks, 1 year and 2 years post-arthroscopy. Synovial chemokine expression was determined by quantitative real-time pcr.
There were significant improvements from the pre-operative baseline Lysholm scores at all three post-operative time points (Kruskal-Wallis p<0.0001), with a mean (+/-SD) improvement at 2 years of 27 (+/-16) points. Despite having worse pre-operative Lysholm scores (Mann Whitney p= 0.0008), patients with synovial inflammation did not generally have worse Lysholm scores compared to patients without inflammation in follow-up (p>0.05). Patients with synovitis showed greater mean improvement in Lysholm scores at 16 week and 1 year (p = 0.02 and p=0.03), but only a trend by 2 years (p=0.054) compared to patients without synovial inflammation. mRNA relative expression levels of CCL19 and CCR7 were also associated with greater improvements in Lysholm scores at the 16 week (CCL19: Spearman r=0.71, p = 0.049; CCR7: r = 0.71, p = 0.02), and 2 year timepoints (CCL19: r= 0.85, p = 0.004; CCR7: r = 0.79, p = 0.002).
In this cohort of patients with meniscal tears and pre-radiographic OA undergoing arthroscopic partial meniscectomy, synovitis identified histologically did not predict worse Lysholm scores up to 2 years post-operatively. Patients with inflammation, measured both histologically and by expression of CCL19 and CCR7, demonstrated greater symptom improvement which was significant at multiple follow-up time points, indicating that these patients may be more responsive to surgical intervention. Radiographic evidence of OA at the time of arthroscopy has been associated with poorer outcomes. It is possible that in this radiographically normal population, longer follow-up is needed to identify patients who develop progressive knee symptoms after surgical intervention for meniscal tears.
To cite this abstract, please use the following information:
Scanzello, Carla R., DiCarlo, Edward F., Kanda, Veero, Albert, Anthony, Goldring, Steven R., Richmond, John C., et al; Relationship Between Synovitis and Two-Year Post-Surgical Outcomes in Patients Undergoing Arthroscopic Partial meniscectomy. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1065