Preventing arthritic change in a joint with an intra-articular fracture remains a challenge, especially in weight-bearing joints. Hyaluronan (HA) has been proven to be effective in relieving joint pain and improving function in chronic osteoarthritis. However, controversy still exists about its potential use in a joint with an intra-articular fracture and about whether this effect is dependent on molecular weight. We analyzed and compared the effects of two different molecular weight HAs on six osteoarthritis-related proteins expressed in fibroblast-like synoviocytes from 12 patients with tibial plateau fracture.
The interleukin (IL)-1beta-stimulated or IL-1beta-unstimulated fibroblast-like synoviocytes were cultivated with or without treatment by two different molecular weight HAs. The production of these proteins was quantified by using commercially available sandwich enzyme-linked immunosorbent assay.
The results revealed that HA with a high molecular weight is more effective in downregulating proinflammatory cytokines such as interleukin-1beta and tumor necrosis factor-alpha. Conversely, HA with a low molecular weight has greater efficacy in upregulating anticatabolic enzymes, such as tissue inhibitor of metalloproteinase-1 and tissue inhibitor of metalloproteinase-2, and in suppressing the catabolic enzyme, matrix metalloproteinase-3, which are thought to be more chondroprotective.
In a knee joint with an intra-articular fracture of the tibial plateau, we posit that high molecular weight HA may have a better anti-inflammatory effect, whereas low molecular weight HA has superior efficacy for chondroprotection.