Foot & Ankle

Inflammatory cytokines and matrix metalloproteinases in ankle fracture X-ref

The aetiology of arthritis in general is still a mystery, with a clear attributable cause in only a handful of cases. In the ankle, post-traumatic degeneration is a common cause and is often witnessed despite anatomical reduction and expedient treatment of osteochondral defects. Although the cause is understood, the mechanism is not. Investigators from Durham (USA) propose a role for inflammatory cytokines in the mediation of post-traumatic osteoarthritis in this elegant study,³ although in itself this is nothing new and has been described in the post-ACL rupture population. Their basic science study focuses on measuring expression of metalloproteases, interleukins and various cytokines aspirated from injured ankles at an average of 17 days post injury. The opportunity was taken to aspirate the normal side, and differences compared. Despite the small study numbers (normal for this type of expression analysis), the researchers measured some marked differences in the MMP and interleukin levels between joints in the same subjects. This then raises the question: is the die cast at the moment of the initial injury and hence is arthritis in some cases inevitable regardless of intervention? Perhaps not. The authors conclude that articular lavage is a sensible idea after fixation and may yet minimise this process. A longitudinal study would be required to answer that question; this kind of study could well confirm potential novel targets for post-traumatic therapies to reduce the rate and risk of degenerative change.