A systematic review on the potential value of synovial fluid biomarkers to predict clinical outcomes in cartilage repair treatments

B Lineham; A Altaie; P Harwood; D McGonagle; H Pandit; E Jones

doi:10.1016/j.joca.2022.05.007

A systematic review on the potential value of synovial fluid biomarkers to predict clinical outcomes in cartilage repair treatments

Osteoarthritis Cartilage. 2022 Aug;30(8):1035-1049. doi: 10.1016/j.joca.2022.05.007. Epub 2022 May 23.

Authors

B Lineham¹, A Altaie², P Harwood³, D McGonagle², H Pandit³, E Jones²

Affiliations

¹ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK. Electronic address: mn13bl@leeds.ac.uk.
² Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.
³ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK.

PMID: 35618204
DOI: 10.1016/j.joca.2022.05.007

Abstract

Objective: Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions.

Method: PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and Quality Assessment of Diagnostic Accuracy Score 2 (QUADAS-2) analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared.

Results: 9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies.

Conclusion: This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context.

Registration number: PROSPERO CRD42022304298. Study protocol available on PROSPERO website.

Keywords: Biomarkers; Cartilage repair; Regeneration; Synovial fluid.

Publication types

Review
Systematic Review

MeSH terms

Biomarkers / analysis
Cartilage, Articular* / chemistry
Humans
Knee Joint / chemistry
Osteoarthritis* / diagnosis
Osteoarthritis, Knee* / diagnosis
Osteoarthritis, Knee* / surgery
Synovial Fluid / chemistry

Substances

Biomarkers