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Scientific Articles   |    
Identification of a Novel Fibronectin-Aggrecan Complex in the Synovial Fluid of Knees with Painful Meniscal Injury
Gaetano J. Scuderi, MD1; S. Raymond Golish, MD, PhD1; Frank F. Cook, MD2; Jason M. Cuellar, MD, PhD3; Robert P. Bowser, PhD4; Lewis S. Hanna, PhD5
1 Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063-6342. E-mail address for G. Scuderi: gscuderi@stanford.edu
2 Jupiter Medical Center, 2055 Military Trail #204, Jupiter, FL 33458
3 Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, 550 First Avenue, New York, NY 10016
4 Department of Pathology, University of Pittsburgh, 200 Lothrop Street, Room S420, S-BST, Pittsburgh, PA 15261
5 Cytonics Corporation, 555 Heritage Drive, #115, Jupiter, FL 33458
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Cytonics, Inc.).

Investigation performed at Jupiter Outpatient Medical Center, Jupiter, Florida
A commentary by Armando F. Vidal, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 16;93(4):336-340. doi: 10.2106/JBJS.J.00718
A commentary by Armando F. Vidal, MD, is available here
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Abstract

Background: 

Molecular biomarkers associated with knee pain may be useful as diagnostic modalities, prognostic indicators, and surrogate end points for therapeutic trials. The present study describes a novel complex of fibronectin and aggrecan that is present in the affected knee of patients with pain and meniscal abnormality.

Methods: 

The present prospective study included thirty patients with knee pain, mechanical symptoms, and magnetic resonance imaging findings that were positive for a meniscal tear who chose arthroscopic partial meniscectomy after unsuccessful nonoperative management. Synovial fluid was aspirated at the time of surgery and was assayed for the fibronectin-aggrecan complex with use of a heterogeneous enzyme-linked immunosorbent assay (ELISA). The results were compared with knee aspirates from ten asymptomatic volunteers with no pain who underwent magnetic resonance imaging of the knee.

Results: 

The mean optical density (and standard deviation) of the fibronectin-aggrecan complex was significantly greater in synovial fluid from knees undergoing arthroscopic surgery as compared with fluid from asymptomatic controls (13.29 ± 8.48 compared with 0.03 ± 0.09; p < 0.001). The mean age in the study group was significantly greater than in control group (46.0 ± 12.6 compared with 38.5 ± 6.0 years; p = 0.02), but controlling for age did not affect the results. Post hoc, an optical density cutoff value of 0.3 distinguished the study group from the control group with 100% accuracy.

Conclusions: 

A novel fibronectin-aggrecan complex is present in the synovial fluid of painful knees with meniscal abnormality. The fibronectin-aggrecan complex may prove to be useful as a clinical biomarker or therapeutic target. Further research is warranted to correlate functional outcome after surgery with the fibronectin-aggrecan complex and other cartilage biomarkers.

Level of Evidence: 

Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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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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