Knee
pain is commonly seen in orthopedic and rehabilitation outpatient clinical settings, and in the aging population.
Bursitis of the knee joint, especially when the volume of the synovial fluid is large enough, can compress and distend the nearby soft tissues, causing
pain in the knee joint. Out of all the bursae surrounding the knee joint, supra-patellar
bursitis is most often associated with knee
pain. Treatment strategies in managing supra-patellar
bursitis include the aspiration of joint synovial fluid and then followed by
steroid injection into the bursa. When supra-patellar
bursitis is caused by degenerative disorders, the concept of
viscosupplementation treatment may be effective by injecting
hyaluronic acid into the bursa. However, the rheology or the changes in the concentrations of
proteins (
biomarkers) that are related to the development of
bursitis in the synovial fluid is virtually unexplored. Therefore, this study aimed to identify the concentration changes in the synovial fluid total
protein amount and individual
proteins associated with supra-patellar
bursitis using the Bradford
protein assay and western
immunoglobulin methods. A total of 20 patients were divided into two groups with 10 patients in each group. One group received the high molecular weight
hyaluronic acid product of
Synvisc Hylan G-F 20 and the other group received the low molecular weight
hyaluronic acid product of Hya-Joint Synovial Fluid Supplement once per week injection into the bursa for a total of 3 weeks. Significant decreases in the synovial fluid total
protein concentrations were observed after the second dosage of high molecular weight
hyaluronic acid injections.
Apolipoprotein A-I,
interleukin 1 beta,
alpha 1 antitrypsin, and
matrix metalloproteinase 1 proteins revealed a trend of decreasing western immunoblotting band densities after
hyaluronic acid injections. The decreases in
apolipoprotein A-I and
interleukin 1 beta protein band densities were significant in the high molecular weight
hyaluronic acid injection group.
Transthyretin,
complement 5, and
matrilin 3 proteins revealed a trend of increasing western immunoblotting band densities after
hyaluronic acid injections.
Transthyretin revealed significant increases in
protein band densities in both the high and low molecular weight
hyaluronic acid injection groups. This study may provide the rationale for targeting several
biomarkers associated with
lipid transport,
inflammation, and anti-aging as possible disease modifying
therapies for the treatment of supra-patellar
bursitis and even degenerative joint disorders.