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Immunohistologic Analysis of Synovium in Infrapatellar Fat Pad After Anterior Cruciate Ligament Injury

Department of Orthopaedic Surgery, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

Takeshi Muneta, MD

Department of Orthopaedic Surgery, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

Kohtaro Furuya, MD

Department of Orthopaedic Surgery, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

Ichiro Saito, DDS PhD

Department of Virology and Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

Nobuyuki Miyasaka, MD

Department of Virology and Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

Haruyasu Yamamoto, MD

Department of Orthopaedic Surgery, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

To clarify the natural course of synovitis after anterior cru ciate ligament injury, we took synovial tissues at various periods after injury and analyzed them immunohistologi cally. Twelve patients with isolated anterior cruciate liga ment injuries participated in the study. Inflammation in tensity was graded semiquantitatively based on the following parameters: synovial lining cell depth, synovial hyperplasia, vascular hyperplasia, lymphocyte infiltration, and the expression of cell adhesion molecules. The ex pression of fibrogenic cytokines and the degree of fibrosis were also investigated to elucidate the mechanisms of ar throfibrosis. The results demonstrated that synovitis in the infrapatellar fat pad subsides within 3 months after injury with the progression of fibrosis. Fibrogenic cytokines, platelet-derived growth factor and transforming growth factor-ß, were detected at fibrotic sites, suggesting their involvement in arthrofibrosis. An increased incidence of arthrofibrosis recently has been recognized to occur when anterior cruciate ligament reconstruction is performed within several weeks after injury. We speculate that when anterior cruciate ligament reconstruction is performed dur ing the stage of acute synovitis, the operation may further promote the synovitis, accelerating the arthrofibrotic re action. Waiting to perform the anterior cruciate ligament reconstruction until the synovitis resolves may possibly decrease the motion problems seen postoperatively.

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