Science and Innovations in MedicineScience and Innovations in MedicineНаука и инновации в медицине2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation66091310.35693/SIM660913Traumatology and OrthopedicsТравматология и ортопедияResearch ArticleDevelopment and risk factors of chronic pain due to trauma to the anterior cruciate ligament and/or meniscus of the knee jointРазвитие и факторы риска хронической боли после травмы передней крестообразной связки и/или мениска коленного суставаhttps://orcid.org/0000-0002-5256-7346ByalikAnastasiya A.БяликАнастасия Андреевна
Russian Federation

postgraduate student, traumatologist-orthopedist

аспирант, врач травматолог-ортопед

nas36839729@yandex.ruhttps://orcid.org/0000-0002-1391-0711KarateevAndrei E.КаратеевА. Е.
Russian Federation

MD, Dr. Sci. (Medicine), Head of the Department of Inflammatory Joint Diseases

д-р мед. наук, начальник отдела воспалительных заболеваний суставов

aekarat@yandex.ruhttps://orcid.org/0000-0001-8563-0631MakarovSergei A.МакаровC. А.
Russian Federation

MD, Cand. Sci. (Medicine), Head of the Department of Traumatology and Orthopedics

канд. мед. наук, заведующий отделением травматологии и ортопедии

smakarov59@rambler.ruhttps://orcid.org/0000-0001-7938-1536ByalikЕvgenii I.БяликЕ. И.
Russian Federation

MD, Dr. Sci. (Medicine), Professor, leading researcher of the laboratory of rheumatoid orthopedics and rehabilitation, traumatologist-orthopedist

д-р мед. наук, профессор, ведущий научный сотрудник лаборатории ревмоортопедии и реабилитации

sklifbialik@yandex.ruhttps://orcid.org/0000-0002-3745-0924ByalikValerii Е.БяликВ. Е.
Russian Federation

MD, Cand. Sci. (Medicine), traumatologist-orthopedist

канд. мед. наук, врач травматолог-ортопед

DoctorBjalik@yandex.ruhttps://orcid.org/0000-0002-7179-8174NesterenkoVadim A.НестеренкоВ. А.
Russian Federation

MD, Cand. Sci. (Medicine), Junior Researcher at the Laboratory of Pathophysiology of Pain and Polymorphism of Musculoskeletal Diseases

канд. мед. наук, младший научный сотрудник лаборатории патофизиологии боли и полиморфизма скелетно-мышечных заболеваний

swimguy91@mail.ruhttps://orcid.org/0000-0002-1084-3920KudinskyDaniil M.КудинскийД. М.
Russian Federation

MD, Cand. Sci. (Medicine), Junior researcher at the laboratory of instrumental diagnostics, radiologist

канд. мед. наук, младший научный сотрудник лаборатории инструментальной диагностики, врач-рентгенолог

Jet56@yandex.ruV.A. Nasonova Research Institute of RheumatologyФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»V.A. Nasonova Research Institute of RheumatologyФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»Russian Medical Academy of Continuous Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России26032025100620251021471542502202525022025Copyright ©; 2025, Byalik A.A., Karateev A.E., Makarov S.A., Byalik Е.I., Byalik V.Е., Nesterenko V.A., Kudinsky D.M.Copyright ©; 2025, Бялик А.А., Каратеев А.Е., Макаров C.А., Бялик Е.И., Бялик В.Е., Нестеренко В.А., Кудинский Д.М.2025Byalik A.A., Karateev A.E., Makarov S.A., Byalik Е.I., Byalik V.Е., Nesterenko V.A., Kudinsky D.M.Бялик А.А., Каратеев А.Е., Макаров C.А., Бялик Е.И., Бялик В.Е., Нестеренко В.А., Кудинский Д.М.https://creativecommons.org/licenses/by/4.0https://innoscience.ru/2500-1388/article/view/660913

Aim – to evaluate the incidence and risk factors of chronic post-traumatic pain in patients who suffered an anterior cruciate ligament (ACL) and/or knee joint meniscus (CC) injury.

Material and methods. The study group consisted of 148 patients (48.0% women, 37.9 ± 13.1 years old) who had suffered an injury to the PC and/or meniscus of the CS, confirmed by magnetic resonance imaging (MRI). The inclusion criterion was moderate/severe pain (≥4 on the numerical rating scale, NRS 0-10) 1 month after the injury. Patients were examined after 3, 6, and 12 months with an assessment of pain (NRS) and the KOOS index, signs of neuropathic pain (painDETECT), anxiety and depression (HADS a and HADS d), central sensitization index (CSI), pain catastrophization (PCS), fibromyalgia symptoms (FiRST), fatigue (FACIT). An MRI scan was performed after 6 and 12 months. The plasma concentrations of a number of biomarkers (HCRP, NTX, ADAMTS-5, COMP, MMP3, MMP9, MMP13, substance P) were studied.

Results. After 3 months, pain with movement ≥4 NRS was observed in 58 (39.2%) patients. These patients formed the group with chronic post-traumatic pain (CPTP+), patients with lower pain intensity or absence (≤4 NRS) formed the control group (CPTP-). In patients with CPTP+, compared with the CPTP- group, pain at rest and at night was significantly higher (p <0.001). A significant difference in pain during movement, at rest, and at night, as well as all KOOS scales, remained between the CPTP+ and CPTP- groups after 6 and 12 months. In the CPTP+ group, there was a tendency to a higher frequency of signs of neuropathic pain, anxiety and depression, central sensitization index, pain catastrophization scale and fatigue, however, the difference with the CPTP- group was unreliable. The concentration of biomarkers in the CPTP+ and CPTP- groups did not differ. There was a significant association between CPTP and the female sex (odds ratio = 3.18; 95% confidence interval 1.606-6.297, p<0.001), meniscus injury (OR = 2.132; 95% CI 1.07-4.252, p=0.03), osteitis (OR = 5.734; 95% CI 2.106-15.609, p<0.001) and synovitis (OR = 2.35; 95% CI 1.186-4.656, p=0.013) according to MRI, surgery (reduced the risk of CPTP, OR = 0.385; 95% CI 0.195-0.759, p<0.005), initially severe pain (≥7 NRS, OR = 5.553; 95% CI 1.696-18.179, p=0.002), signs of highly probable CS (CSI ≥40, OR = 3.915; 95% CI 1.147-13.368, p=0.021) and severe depression (HADS ≥ 11, OR = 4.12; 95% CI 1.672-21.983, p=0.05).

Conclusion. CPTP occurs in almost 40% of patients after knee joint meniscus injury. Risk factors for CPTP are female gender, meniscus injury, osteitis and synovitis (MRI data), initially severe pain, central sensitization, and depression.

Цель – оценить частоту развития и факторы риска ХПТБ у пациентов, перенесших травму передней крестообразной связки (ПКС) и/или мениска коленного сустава (КС).

Материал и методы. Исследуемую группу составили 148 пациентов (женщины 48,0%, 37,9 ± 13,1 года), перенесших травму ПКС и/или мениска КС, подтвержденную магнитно-резонансной томографией (МРТ). Критерием включения была умеренная/выраженная боль (≥4 по числовой рейтинговой шкале, ЧРШ 0–10) через 1 месяц после травмы. Пациенты обследовались через 3, 6 и 12 месяцев с оценкой боли (ЧРШ) и индекса KOOS, признаков невропатической боли (PainDETECT), тревоги и депрессии (HADS a и HADS d), центральной сенситизации, ЦС (CSI), катастрофизации боли, КБ (PCS), симптомов фибромиалгии, ФМ (FiRST), утомляемости (FACIT). Через 6 и 12 месяцев проводилась МРТ. Была исследована плазменная концентрация ряда биомаркеров (вчСРБ, NTX, ADAMTS-5, COMP, ММП3, ММП9, ММП13, субстанция Р).

Результаты. Через 3 месяца боль при движении ≥4 ЧРШ отмечена у 58 (39,2%) пациентов. Эти пациенты составили группу с ХПТБ (ХПТБ+), пациенты с меньшей интенсивностью или отсутствием боли (≤4 ЧРШ) – контроль (ХПТБ-). У пациентов ХПТБ+ в сравнении с группой ХПТБ- была достоверно выше боль в покое и ночью (p <0,001). Достоверное различие боли при движении, в покое и ночью, а также всеми шкалами KOOS сохранялось между группами ХПТБ+ и ХРТБ- через 6 и 12 месяцев. В группе ХПТБ+ была тенденция к большей частоте признаков невропатической боли, тревоги и депрессии, ЦС, КБ и усталости, однако различие с группой ХПТБ- было недостоверным. Концентрация биомаркеров в группах ХПТБ+ и ХПТБ- не различалась. Отмечена достоверная связь между ХПТБ и женским полом (отношение шансов, ОШ = 3,18; 95% доверительный интервал, ДИ 1,606-6,297, р<0,001), травмой мениска (ОШ = 2,132; 95% ДИ 1,07-4,252, р=0,03), остеитом (ОШ = 5,734; 95% ДИ 2,106-15,609, р<0,001) и синовитом (ОШ = 2,35; 95% ДИ 1,186-4,656, р=0,013) по МРТ, проведенной операцией (снижала риск ХПТБ, ОШ = 0,385; 95% ДИ 0,195-0,759, р<0,005), исходно сильной болью (≥7 ЧРШ, ОШ = 5,553; 95% ДИ 1,696-18,179, р=0,002), признаками высоко вероятной ЦС (CSI ≥40, ОШ = 3,915; 95% ДИ 1,147-13,368, р=0,021) и выраженной депрессией (HADS ≥ 11, ОШ = 4,12; 95% ДИ 1,672-21,983, р=0,05).

Заключение. ХПТБ возникает почти у 40% пациентов после травмы КС. Факторы риска ХПТБ – женский пол, травма мениска, остеит и синовит (данные МРТ), исходно сильная боль, ЦС и депрессия.

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