Patients with higher numbers of allergies have lower levels of anti-inflammatory cytokines and increased pain at the time of ACL reconstruction

• Published in: The knee 2024-03, Vol.47, p.27-34
• Main Authors: Lipschultz, Robyn A., Moore, Michael, Montgomery, Samuel R., Wolfe, Isabel, Strauss, Eric
• Format: Article
• Language: English
• Subjects: Adult; Allergy; Anterior Cruciate Ligament Injuries - complications; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction; Biomarkers; Case-Control Studies; Cytokine; Cytokines - metabolism; Female; Humans; Hypersensitivity; Interleukin 1 Receptor Antagonist Protein; Knee; Male; Retrospective Studies; Synovial fluid; Synovial Fluid - immunology; Synovial Fluid - metabolism; Young Adult
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2023.12.010

Synovial fluid biomarkers are well studied indicators of inflammation and healing in the setting of orthopedic injuries. However, it has not been studied if patients with one or more allergies have a difference in the concentrations of synovial fluid inflammatory cytokines compared to patients without allergies. The purpose of the current study is to analyze the concentration of 10 pro- and anti-inflammatory cytokines in the synovial fluid of isolated ACL injury patients with and without at least one allergy. Retrospective Case-Control. A database of patients who underwent surgery for isolated ACL injury between September 2011 and July 2023 was analyzed. All patients had SF aspirated from the operative knee prior to the surgical incision and the concentrations of pre- and anti-inflammatory biomarkers were quantified. From this cohort, 24 patients were identified to have allergies by chart review. These patients were matched 1:1 to 24 patients without allergies based on age and sex. There were no significant differences between the allergy and no allergy cohorts with respect to age (28.5 ± 10.3 vs. 29.5 ± 8.9, p = 0.76) and sex (70.8 % female vs. 70.8 % female, p = 1.00). The allergy cohort had a decreased concentration of TIMP-1 (492.41 ± 616.20 ng/mL vs. 1041.48 ± 942.04 ng/mL, p = 0.03) and IL-1Ra (101.70 ± 93.37 pg/mL vs. 359.94 ± 399.77 pg/mL, p = 0.01) compared to patients without allergies. A linear regression analysis found a significant association between increasing number of patients reported allergies and decreasing concentration of TIMP-1 (β = -231.59, p = 0.03) and IL-1Ra (β = -71.69p = 0.03) concentrations when controlling for age and sex. Finally, the allergy cohort was found to have a significantly higher value for the VAS pain scale at the time of surgery (26.84 ± 24.73 vs. 7.37 ± 10.98, p