Caitlin E. W. Conley

Anterior cruciate ligament (ACL) injury initiates a biochemical cascade thought to contribute to the onset and progression of posttraumatic osteoarthritis (PTOA). Interleukin‐1ß (IL‐1ß), IL‐6, and C‐telopeptide fragments of type II collagen (CTX‐II) are implicated in joint inflammation and cartilage degradation following ACL injury; however, their association with pain is still being explored. The purpose of this study was to evaluate the associations between synovial fluid concentrations of IL‐1ß, IL‐6, and CTX‐II with pain following ACL injury and reconstruction. We hypothesized that greater IL‐1ß, IL‐6, and CTX‐II would correlate with greater Pain Visual Analogue Scale (VAS) scores. This was a secondary analysis of 23 patients (mean age = 18.4 years, BMI = 27.4, 13 females/10 males) with acute ACL tears who participated in a pilot randomized trial. Synovial fluid and VAS scores were collected on the day of initial presentation, at ACL reconstruction, and 1 and 4 weeks after surgery. Synovial fluid concentrations of IL‐1ß, IL‐6, and CTX‐II were assessed using enzyme‐linked immunoabsorbent assays, and repeated measures correlations were used to assess the relationships between pain and synovial IL‐1ß, IL‐6, or CTX‐II after ACL injury and reconstruction. Pain was positively correlated with synovial fluid IL‐6 concentrations ( r = 0.52, p < 0.001); however, pain was inversely correlated with CTX‐II ( r = −0.39, p = 0.002). IL‐1ß had no significant correlation with pain. Statement of clinical relevance: PTOA has been described as a “silent killer” and these results suggest that early PTOA may have pro‐inflammatory pathways that are not primarily associated with pain but still lead to progressive cartilage loss.

Objective To identify the prevalence of mood disorder diagnoses in patients undergoing cartilage transplantation procedures and determine the relationship between mood disorders, opioid usage, and postoperative health care costs. Design Patients with current procedural terminology (CPT) codes for osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI) were identified in the Truven Health Marketscan database (January 2009-September 2014). Patients were grouped based on having a preoperative mood disorder diagnosis (preMDD). Preoperative opioids, postoperative opioids ≥90 days, and health care costs within the year postoperative were compared for those with and without mood disorders. Costs were analyzed, adjusting for preoperative cost, sex, age, and opioid usage, for those with and without mood disorders. Results A total of 3,682 patients were analyzed (ACI: 690, OAT: 1,294, OCA: 1,698). A quarter of patients had preMDD (ACI: 25.4%, OAT: 20.6%, OCA: 22.7%). Postoperative opioid use was more prevalent in preMDD patients (OAT: 37.1% vs. 24.1%, P < 0.001; OCA: 30.4% vs. 24.8%, P = 0.032; ACI: 33.7% vs. 26.2%, P = 0.070) (odds ratio [OR] ranged from 1.29 to 1.86). First-year postoperative log-transformed costs were significantly greater for preMDD patients (ACI: $7,733 vs. $5,689*, P = 0.012; OAT: $5,221 vs. $3,823*, P < 0.001; OCA: $6,973 vs. $3,992*, P < 0.001; *medians reported). The estimated adjusted first postoperative year cost increase for preMDD OCA patients was 41.7% ( P < 0.001) and 28.0% for OAT patients ( P = 0.034). There was no statistical difference for ACI patients ( P = 0.654). Conclusion Cartilage transplantation patients have a high prevalence of preoperative mood disorders. Opioid use and health care costs were significantly greater for patients with preoperative mood disorder diagnoses. Level of Evidence: Level III, retrospective therapeutic study.