Burak AKESEN, Burak DEMİRAĞ, FERAH BUDAK

Ön çapraz bağ cerrahisinde eklemiçi sıvıda ameliyat öncesi ve sonrası kollajenaz, TIMP-1 ve TNF-α düzeyleri

Amaç: Bu çalışmada, ön çapraz bağ (ÖÇB) cerrahisinden sonra kemik-tendon iyileşmesinde etkili olduğunu düşün- düğümüz kollajenazların, bu kollajenazların salınımını düzenleyen sitokinlerden olan tümör nekroz faktör-alfa (TNF–α) ve kollajenaz enzimlerinin doğal inhibitörü olan TIMP-1 enzimi düzeyleri sinovyal sıvıda araştırıldı. Çalışma planı: Çalışmaya, izole ÖÇB cerrahisi uygu- lanan hastalar arasından, ameliyat sonrası takiplerde diz ekleminde efüzyon gelişen ve bu nedenle ameliyat sonrası artrosentez yapılan 16 hasta (15 erkek, 1 kadın; ort. yaş 27; dağılım 17-40) alındı. Bu hastalardan ameliyat sırasında ve sonrasında alınan sinovyal sıvı örneklerinde kollajenaz, TNF–α ve TIMP-1 düzeyleri uygun kitler kullanılarak öl- çüldü. Ön çapraz bağın kopması ile ameliyat arasında ge- çen süre ortalama 21±10 ay (dağılım 1-72 ay), ameliyattan sonra artrosentez sırasında eklemiçi sıvı alma için geçen süre ortalama 18 saat (dağılım 12-36 saat) idi. Sonuçlar: Ameliyat sırasında ve sonrasında alınan ekle- miçi sinovyal sıvı örneklerinde ölçülen değerler kollajenaz için sırasıyla 1.49±0.06 ng/ml ve 1.45±0.05 ng/ml, TIMP-1 için 12±5 ng/ml ve 22±9.5 ng/ml, TNF-α için 10.4±7.1 pr/ ml ve 14.11±6.1 pr/ml bulundu. Kollajenaz ve TNF-α açı- sından ameliyat sonrasındaki değişimlerde anlamlı fark- lılık görülmedi (sırasıyla, p=0.098 ve p=0.069); TIMP-1 düzeyindeki artış ise anlamlıydı (p=0.026). Çıkarımlar: Çalışmamızdaki dizlerde ÖÇB kopuk ol- duğundan, TNF-α, kollajenaz, TIMP-1 düzeyleri yüksek bulunmuştur. Verilerimiz bu değerlerin ameliyat sonrası yakın dönemde nasıl değişim geçirdiğini göstermiştir.

Anahtar Kelimeler:

Ön çapraz bağ, Ameliyat sonrası dönem, Sinoviyal sıvı, Tümör nekrozis faktör-alfa, Metalloproteinaz-1 doku inhibitörü, Kollajenazlar, Matriks metaloproteinazlar, İzleme, ameliyat sırasında, Rekonstrüktif cerrahi işlemler, Yırtılma, spontan

Evaluation of intra-articular collagenase, TIMP-1, and TNF-α levels before and after anterior cruciate ligament reconstruction

Objectives: We investigated intra-articular levels of colla- genase, which presumably promotes bone-tendon healing, and collagenase mediators involved in its production (tu- mor necrosis factor-alpha, TNF-α) and inhibition (TIMP-1 enzyme) in patients following anterior cruciate ligament (ACL) reconstruction. Methods: The study included 16 patients (15 males, 1 fe- male; mean age 27 years; range 17 to 40 years) who under- went arthrocentesis due to effusion that developed follow- ing reconstruction of isolated ACL injuries. Intra-articular levels of collagenase, TNF-α, and TIMP-1 were measured using appropriate activity assay and immunoassay kits in synovial ﬂuid samples obtained intraoperatively and dur- ing arthrocentesis. The mean time from ACL injury to sur- gical repair was 21±10 months (range 1 to 72 months). Ar- throcentesis was performed in a mean of 18 hours (range 12 to 36 hours) following ACL repair. Results: Measurements in synovial ﬂuid samples obtained intra- and postoperatively yielded 1.49±0.06 ng/ml and 1.45±0.05 ng/ml for collagenase, 12±5 ng/ml and 22±9.5 ng/ml for TIMP-1, and 10.4±7.1 pr/ml and 14.11±6.1 pr/ml for TNF-α, respectively. Postoperative changes in the lev- els of collagenase (p=0.098) and TNF-α (p=0.069) were not signiﬁcant, whereas increase in the TIMP-1 level was signiﬁcant (p=0.026). Conclusion: This study showed elevated levels of TNF-α, collagenase, and TIMP-1 due to the presence of ruptured ACL. Our ﬁndings showed how these levels changed in the acute postoperative period.

Keywords:

Anterior Cruciate Ligament, Postoperative Period, Synovial Fluid, Tumor Necrosis Factor-alpha, Tissue Inhibitor of Metalloproteinase-1, Collagenases, Matrix Metalloproteinases, Monitoring, Intraoperative, Reconstructive Surgical Procedures, Rupture, Spontaneous,

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