Evaluation of intra-articular collagenase, TIMP-1, and TNF-a levels before and after anterior cruciate ligament reconstruction

Objectives: We investigated intra-articular levels of colla¬genase, which presumably promotes bone-tendon healing, and collagenase mediators involved in its production (tu¬mor necrosis factor-alpha, TNF-a) and inhibition (TIMP-1 enzyme) in patients following anterior cruciate ligament (ACL) reconstruction. Methods: The study included 16 patients (15 males, 1 fe¬male; mean age 27 years; range 17 to 40 years) who under¬went arthrocentesis due to effusion that developed follow¬ing reconstruction of isolated ACL injuries. Intra-articular levels of collagenase, TNF-a, and TIMP-1 were measured using appropriate activity assay and immunoassay kits in synovial fluid samples obtained intraoperatively and dur¬ing arthrocentesis. The mean time from ACL injury to sur¬gical repair was 21±10 months (range 1 to 72 months). Ar- throcentesis was performed in a mean of 18 hours (range 12 to 36 hours) following ACL repair. Results: Measurements in synovial fluid samples obtained intra- and postoperatively yielded 1.49±0.06 ng/ml and 1.45±0.05 ng/ml for collagenase, 12±5 ng/ml and 22±9.5 ng/ml for TIMP-1, and 10.4±7.1 pr/ml and 14.11±6.1 pr/ml for TNF-a, respectively. Postoperative changes in the lev¬els of collagenase (p=0.098) and TNF-a (p=0.069) were not significant, whereas increase in the TIMP-1 level was significant (p=0.026). Conclusion: This study showed elevated levels of TNF-a, collagenase, and TIMP-1 due to the presence of ruptured ACL. Our findings showed how these levels changed in the acute postoperative period.