Scientific Articles   |    
Effect of Tibial Plateau Fracture on Lubrication Function and Composition of Synovial Fluid
Brooke L. Ballard, MD1; Jennifer M. Antonacci, PhD2; Michele M. Temple-Wong, PhD2; Alexander Y. Hui, BS2; Barbara L. Schumacher, BS2; William D. Bugbee, MD1; Alexandra K. Schwartz, MD1; Paul J. Girard, MD1; Robert L. Sah, MD, ScD2
1 Department of Orthopaedic Surgery, Mail Code 8894, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8894
2 Department of Bioengineering, Mail Code 0412, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412. E-mail address for R.L. Sah: rsah@ucsd.edu
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Investigation performed at the Department of Orthopaedic Surgery, University of California, San Diego, San Diego, and Department of Bioengineering, University of California, San Diego, La Jolla, California

Brooke L. Ballard, MD, and Jennifer M. Antonacci, PhD, contributed equally to the preparation of this article.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 16;94(10):e64 1-9. doi: 10.2106/JBJS.K.00046
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Intra-articular fractures may hasten posttraumatic arthritis in patients who are typically too active and too young for joint replacement. Current orthopaedic treatment principles, including recreating anatomic alignment and establishing articular congruity, have not eliminated posttraumatic arthritis. Additional biomechanical and biological factors may contribute to the development of arthritis. The objective of the present study was to evaluate human synovial fluid for friction-lowering function and the concentrations of putative lubricant molecules following tibial plateau fractures.


Synovial fluid specimens were obtained from the knees of eight patients (twenty-five to fifty-seven years old) with a tibial plateau fracture, with five specimens from the injured knee as plateau fracture synovial fluid and six specimens from the contralateral knee as control synovial fluid. Each specimen was centrifuged to obtain a fluid sample, separated from a cell pellet, for further analysis. For each fluid sample, the start-up (static) and steady-state (kinetic) friction coefficients in the boundary mode of lubrication were determined from a cartilage-on-cartilage biomechanical test of friction. Also, concentrations of the putative lubricants, hyaluronan and proteoglycan-4, as well as total protein, were determined for fluid samples.


The group of experimental samples were obtained at a mean (and standard deviation) of 11 ± 9 days after injury from patients with a mean age of 45 ± 13 years. Start-up and kinetic friction coefficients demonstrated similar trends and dependencies. The kinetic friction coefficients for human plateau fracture synovial fluid were approximately 100% higher than those for control human synovial fluid. Hyaluronan concentrations were ninefold lower for plateau fracture synovial fluid compared with the control synovial fluid, whereas proteoglycan-4 concentrations were more than twofold higher in plateau fracture synovial fluid compared with the control synovial fluid. Univariate and multivariate regression analysis indicated that kinetic friction coefficient increased as hyaluronan concentration decreased.


Knees afflicted with a tibial plateau fracture have synovial fluid with decreased lubrication properties in association with a decreased concentration of hyaluronan.

Clinical Relevance: 

Tibial plateau fractures result in a posttraumatic deficiency in synovial fluid lubrication function.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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