Biologic Therapy to Prevent Osteoarthritis After ACL Injury

Summary

Participation Requirements

Description

After appropriate IRB approval at total of 48 active patients who meet the inclusion criteria listed above will be randomized into three treatment groups: Group 1 (n = 16) will undergo ultrasound guided arthrocentesis of the knee hemarthrosis at the time of presentation in clinic. Following aspirati...

After appropriate IRB approval at total of 48 active patients who meet the inclusion criteria listed above will be randomized into three treatment groups: Group 1 (n = 16) will undergo ultrasound guided arthrocentesis of the knee hemarthrosis at the time of presentation in clinic. Following aspiration of the knee joint hemarthrosis, an injection of 5 milliliters (mls) of 0.9% sodium chloride solution (sterile saline) will be administered as a placebo control. In addition, a second aspiration of knee joint fluid and injection of sterile saline into the injured knee joint will be performed at 10 days post-injury. Group 2 (n = 16) will undergo arthrocentesis as described in group 1 as well as intra-articular administration of 150mg (~5mls) of anakinra (rhIL-1Ra) within 7 days of ACL injury. In addition, repeat knee joint fluid aspiration and a second injection of 5mls of sterile saline into the injured knee joint will be performed at 10 days post-injury. Group 3 patients will receive arthrocentesis and injection of anakinra as described in group 2 as well as a second knee joint aspiration and intra-articular knee injection of anakinra (150mg, ~5mls) on post-injury day 10. Thus, all patients will undergo two ultrasound guided knee aspiration and injection procedures prior to surgery. The first injection will be after the arthrocentesis procedure to remove the hemarthrosis associated with acute ACL injury. To minimize pain and discomfort the same needle stick will be used to aspirate the hemarthrosis and to inject the saline or anakinra depending on the patient's treatment group. The second knee arthrocentesis and injection in each patient will also be performed under ultrasound-guidance at 10 days after injury. Some patient's injuries may fall on a day where performing these aspiration and injection procedures exactly 10 days after injury is not possible due to constraints of the work week (i.e. Monday through Friday). In this case the procedures will be performed on the next consecutive work day closest to the 10 days post-injury time point. An additional arthrocentesis procedure will be performed at the time of surgery. Study patients in all 3 groups will undergo pre-operative collection of urine and knee joint fluid as described above. These time points include: i) at the time of enrollment into the study (within 7 days of injury), ii) at 10 days after injury, iii) on the day of surgery (within 30 days of injury). In addition, urine and knee joint fluid collection will be performed at the initial post-operative visit (approximately 10 days after surgery) followed by collection of urine alone at 3, 6, 9, 12 and 24 months post-operatively in all treatment groups. Urine and arthrocentesis samples will be analyzed for the presence of inflammatory cytokines and cartilage breakdown biomarkers according to Osteoarthritis Research Society International guidelines (see cytokine and biomarker assays section below for further details). Given, that multiple studies have demonstrated resolution of cytokine abnormalities by 2 to 4 weeks after ACL injury, urine assessments of cytokine assays (IL-1, etc.) will not be conducted beyond 3 months post-operatively. However, ELISAs for cartilage biomarkers will be performed on urine collected at each time point throughout the duration of the study. Validated patient reported outcome assessments (KOOS, VAS and PROMIS) will be completed at initial presentation as well as at 6, 9, 12 and 24 month post-operatively. Patients in all 3 groups will be also be followed longitudinally with repeat MR imaging that includes cartilage sensitive sequences (T1rho). These will be obtained at 12 and 24 months post-operatively. Additional MRI studies at earlier time points are optional for study participants. The MRI studies performed in this investigation will be non-arthrogram studies without intra-articular or intravenous contrast. The injured and contralateral uninjured knee will be imaged with MRI at 12 and 24 months after surgery. This study will be a single-blinded design and all aspects of the study design will be disclosed to subjects during the informed consent process. Given that anakinra needs to be ordered by the physician from the pharmacy on the day of injection, the physician performing the injection will not be blinded to which patients receive anakinra treatments. However, the patients will be blinded regarding which treatment they receive. All patients will receive injections of the same volume, same color and using the same type of needle and syringe. The synovial fluid and urine biomarker data will be analyzed in a coded fashion in conjunction with a statistician to avoid bias in the statistical analysis. In addition, the radiologist interpreting the MRI studies will be blinded to which treatment the patients receive. The physician administering the injections into the joint will not be involved in interpreting the MRI findings and will not be present when subjects complete the patient-reported outcome measures.

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