Anterior cruciate ligament reconstruction reinitiates an inflammatory and chondrodegenerative process in the knee joint

Emily R. Hunt, Cale A. Jacobs, Caitlin E.W. Conley, Mary L. Ireland, Darren L. Johnson, Christian Lattermann

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Anterior cruciate ligament (ACL) injury leads to a sustained increase in synovial fluid concentrations of inflammatory cytokines and biomarkers of cartilage breakdown. While this has been documented post-injury, it remains unclear whether ACL reconstruction surgery contributes to the inflammatory process and/or cartilage breakdown. This study is a secondary analysis of 14 patients (nine males/five females, mean age = 9, mean BMI = 28) enrolled in an IRB-approved randomized clinical trial. Arthrocentesis was performed at initial presentation (mean = 6 days post-injury), immediately prior to surgery (mean = 23 days post-injury), 1-week post-surgery, and 1-month post-surgery. Enzyme-linked immunosorbant assay kits were used to determine concentrations of carboxy-terminal telopeptides of type II collagen (CTXII), interleukin-6 (IL-6), and IL-1β in the synovial fluid. The log-transformed IL-1β was not normally distributed; therefore, changes between time points were evaluated using a non-parametric Kruskal-Wallis one-way ANOVA. IL-1β concentrations significantly increased from the day of surgery to the first postoperative time point (P ≤.001) and significantly decreased at the 4-week postoperative visit (P =.03). IL-1β concentrations at the 4-week postoperative visit remained significantly greater than both preoperative time points (P >.05). IL-6 concentrations at 1-week post-surgery were significantly higher than at initial presentation (P =.013), the day of surgery (P <.001), and 4 weeks after surgery (P =.002). CTX-II concentrations did not differ between the first three-time points (P >.99) but significantly increased at 4 weeks post-surgery (P <.01). ACL reconstruction appears to reinitiate an inflammatory response followed by an increase in markers for cartilage degradation. ACL reconstruction appears to initiate a second “inflammatory hit” resulting in increased chondral breakdown suggesting that post-operative chondroprotection may be needed.

Original languageEnglish
Pages (from-to)1281-1288
Number of pages8
JournalJournal of Orthopaedic Research
Issue number6
StatePublished - Jun 2021

Bibliographical note

Publisher Copyright:
© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC


  • ACL reconstruction
  • biomarker
  • cartilage
  • inflammation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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