Посттравматический гемартроз с точки зрения теории воспаления

Введение. Посттравматический гемартроз отождествляется в настоящее время с внутрисуставным кровоизлиянием, однако стоит обратить внимание на то, что сопровождается он всеми пятью классическими признаками воспаления: наличием гиперемии, гипертермии, отека, боли, изменением функции сустава.

Цель. На основании анализа мировой научной литературы последних лет установить, стоит ли недооценивать воспаление при посттравматическом гемартрозе.

Материалы и методы. Произведен анализ научной информации из статей поисковой интернет платформы Web of Science (Clarivate Analytics, USA): базы данных Web of Science Core Collection (доступ по подписке), Publons (открытый доступ), Medline (открытый доступ). Изучены материалы научных работ базы данных Scopus (Elsevier, Netherlands). Глубина поиска составила 15 лет. Темы, не получившие освещения в литературе данного периода, изучались, в ряде случаев, до 1960-х годов. По теме исследования обнаружено свыше 200 источников. Анализу подвергалась литература, опубликованная в текущем году, – 15,0 % материалов, в последние 5 лет, включая текущий год, – 56,3 %, в последние 10 лет, включая текущий год, – 73,8 %, в последние 15 лет, включая текущий год, – 81,3 %.

Результаты и обсуждение. Степень повреждения и сопуствующие факторы воспаления определяют быстрое разрешение или более тяжёлый вариант течения посттравматического гемартроза в процессе лечения. Сопряжение нескольких вариантов воспаления приводит к развитию осложнений, в частности, остеоартрит может развиваться в тех случаях, когда на момент травмы уже реализуются механизмы хронического системного воспаления низкой интенсивности, анкилоз сустава может быть следствием хронического системного воспаления низкой интенсивности с вовлечением процессов дегенерации. Синовит, как осложнение посттравматического гемартроза, с позиции теории воспаления должен дифференцироватся на наличие признаков низкосортного воспаления, хронического течения классического воспаления и предсистемного воспаления (гнойный артрит).

Заключение. Анализ современной литературы показал сложность и многогранность аспектов воспаления при посттравматическом гемартрозе. Отсутствие акцентуации на оценке воспалительной реакции при реабилитации пациентов с посстравматическим гемартрозом может приводить к возникновению осложнений лечения, в частности, формировать предпосылки к развитию остеоартроза, анкилоза, синовита.

1. Olsson O, Isacsson A, Englund M, Frobell RB. Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - data from 1145 consecutive knees with subacute MRI. Osteoarthritis Cartilage. 2016;24(11):1890-1897. doi: 10.1016/j.joca.2016.06.006

2. Krutsch W, Krutsch V, Hilber F, Pfeifer C, Baumann F, Weber J, Schmitz P, Kerschbaum M, Nerlich M, Angele P. 11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports. Sportverletz Sportschaden. 2018;32(2):111-119. English. doi: 10.1055/s-0583-3792

3. Kozaci N, Avci M, Yuksel S, Donertas E, Karaca A, Gonullu G, Etli I. Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee. Eur J Trauma Emerg Surg. 2022;48(4):3221-3227. doi: 10.1007/s00068-022-01883-5

4. Brown JS, Frobell RB, Isacsson A, Englund M, Olsson O. Agreement Between Clinical Examination and Magnetic Resonance Imaging in Acute Knee Trauma With Hemarthrosis. Clin J Sport Med. 2022;32(4):401-406. doi: 10.1097/JSM.0000000000000950

5. Barber FA, Prudich JF. Acute traumatic knee hemarthrosis. Arthroscopy. 1993;9(2):174-6. doi: 10.1016/s0749-8063(05)80369-x

6. Harbrecht A, Ott N, Hackl M, Leschinger T, Wegmann K, Müller LP. Radiuskopffrakturen : Epidemiologie, Diagnose, Behandlung und Outcome [Radial head fractures : Epidemiology, diagnosis, treatment and outcome]. Unfallchirurg. 2021;124(2):153-162. German. doi: 10.1007/s00113-020-00947-8

7. Wendling D, Bertrand MA. Hemarthrosis in acquired hemophilia. Two case-reports. Joint Bone Spine. 2003;70(6):532-4. doi: 10.1016/s1297-319x(03)00057-5

8. Souabni L, Meddeb N, Ajlani H, Ben Romdhane N, Sellami S. Hemarthrosis revealing congenital factor XI deficiency. Joint Bone Spine. 2008;75(3):348-9. doi: 10.1016/j.jbspin.2007.06.013

9. Wilkins RA, Stephensen D, Siddle H, Scott MJ, Xiang H, Horn E, Palmer B, Chapman GJ, Richards M, Walwyn R, Redmond A. Twelve-month prevalence of haemarthrosis and joint disease using the Haemophilia Joint Health score: evaluation of the UK National Haemophilia Database and Haemtrack patient reported data: an observational study. BMJ Open. 2022;12(1):e052358. doi: 10.1136/bmjopen-2021-052358

10. Manners PJ, Price P, Buurman D, Lewin B, Smith B, Cole CH. Joint Aspiration for Acute Hemarthrosis in Children Receiving Factor VIII Prophylaxis for Severe Hemophilia: 11-year Safety Data. J Rheumatol. 2015;42(5):885-90. doi: 10.3899/jrheum.141236

11. Pasta G, Jannelli E, Ivone A, Mosconi M, Ferranti Calderoni E, Minen A, Benazzo F, Rodriguez-Merchan EC. The role of six biomarkers in diagnosis of hemophilic arthropathy: review of the literature. J Biol Regul Homeost Agents. 2020;34(3 Suppl. 2):7-13.

12. Canbilen SW, El Abed K, Ahmad R. Spontaneous atraumatic knee haemarthrosis. BMJ Case Rep. 2020;13(10):e236362. doi: 10.1136/bcr-2020-236362

13. Ibrahim M, Booth RE Jr, Clark TW. Embolization of traumatic pseudoaneurysms after total knee arthroplasty. J Arthroplasty. 2004;19(1):123-8. doi: 10.1016/j.arth.2003.08.007

14. Serra TQ, Morais J, Gonçalves Z, Agostinho F, Melo G, Henriques M. An unusual case of diffuse pigmented villonodular synovitis of the shoulder: A multidisciplinary approach with arthroscopic synovectomy and adjuvant radiotherapy. Eur J Rheumatol. 2017;4(2):142-144. doi: 10.5152/eurjrheum.2016.15084

15. Given MF, Smith P, Lyon SM, Robertson D, Thomson KR. Embolization of spontaneous hemarthrosis post total knee replacement. Cardiovasc Intervent Radiol. 2008;31(5):986-8. doi: 10.1007/s00270-007-9257-5

16. Potpally N, Rodeo S, So P, Mautner K, Baria M, Malanga GA. A Review of Current Management of Knee Hemarthrosis in the Non-Hemophilic Population. Cartilage. 2021;13(1_suppl):116S-121S. doi: 10.1177/1947603520942937

17. Blaker CL, Clarke EC, Little CB. Using mouse models to investigate the pathophysiology, treatment, and prevention of post-traumatic osteoarthritis. J Orthop Res. 2017;35(3):424-439. doi: 10.1002/jor.23343

18. Jiao MN, Zhang TM, Yang K, Xu ZY, Zhang GM, Tian YY, Liu H, Yan YB. Absorbance or organization into ankylosis: a microarray analysis of haemarthrosis in a sheep model of temporomandibular joint trauma. BMC Oral Health. 2021;21(1):668. doi: 10.1186/s12903-021-02033-w

19. Ibrahim IO, Nazarian A, Rodriguez EK. Clinical Management of Arthrofibrosis: State of the Art and Therapeutic Outlook. JBJS Rev. 2020;8(7):e1900223. doi: 10.2106/JBJS.RVW.19.00223

20. Alunno A, Falcinelli E, Luccioli F, Petito E, Bartoloni E, Momi S, Mirabelli G, Mancini GB, Gerli R, Gresele P. Platelets Contribute to the Accumulation of Matrix Metalloproteinase Type 2 in Synovial Fluid in Osteoarthritis. Thromb Haemost. 2017;117(11):2116-2124. doi: 10.1160/TH17-06-0379

21. Jansen NW, Roosendaal G, Wenting MJ, Bijlsma JW, Theobald M, Hazewinkel HA, Lafeber FP. Very rapid clearance after a joint bleed in the canine knee cannot prevent adverse effects on cartilage and synovial tissue. Osteoarthritis Cartilage. 2009;17(4):433-40. doi: 10.1016/j.joca.2008.09.001

22. Sogi Y, Yabe Y, Hagiwara Y, Tsuchiya M, Onoda Y, Sekiguchi T, Itaya N, Yoshida S, Yano T, Suzuki K, Onoki T, Itoi E. Joint hemorrhage accelerates cartilage degeneration in a rat immobilized knee model. BMC Musculoskelet Disord. 2020;21(1):761. doi: 10.1186/s12891-020-03795-0

23. Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133(5):321-8. doi: 10.7326/0003-4819-133-5-200009050-00007

24. Li M, Yin H, Yan Z, Li H, Wu J, Wang Y, Wei F, Tian G, Ning C, Li H, Gao C, Fu L, Jiang S, Chen M, Sui X, Liu S, Chen Z, Guo Q. The immune microenvironment in cartilage injury and repair. Acta Biomater. 2022;140:23-42. doi: 10.1016/j.actbio.2021.12.006

25. Lombardi M, Cardenas AC. Hemarthrosis. 2022 Aug 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

26. Connizzo BK, Grodzinsky AJ. Lose-Dose Administration of Dexamethasone Is Beneficial in Preventing Secondary Tendon Damage in a Stress-Deprived Joint Injury Explant Model. J Orthop Res. 2020;38(1):139-149. doi: 10.1002/jor.24451

27. Nozawa-Inoue K, Harada F, Magara J, Ohazama A, Maeda T. Contribution of synovial lining cells to synovial vascularization of the rat temporomandibular joint. J Anat. 2016;228(3):520-9. doi: 10.1111/joa.12426

28. Gusev E, Sarapultsev A, Hu D, Chereshnev V. Problems of Pathogenesis and Pathogenetic Therapy of COVID-19 from the Perspective of the General Theory of Pathological Systems (General Pathological Processes). Int J Mol Sci. 2021;22(14):7582. doi: 10.3390/ijms22147582

29. Gusev E, Solomatina L, Zhuravleva Y, Sarapultsev A. The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation. Int J Mol Sci. 2021;22(21):11453. doi: 10.3390/ijms222111453

30. Malachovsky I, Statelova D, Stasko J, Mikuskova K, Smatanova M, Janickova M. Therapeutic effects of arthrocentesis in treatment of temporomandibular joint disorders. Bratisl Lek Listy. 2019;120(3):235-239. doi: 10.4149/BLL_2019_052

31. Gusev EY, Zotova NV. Cellular Stress and General Pathological Processes. Curr Pharm Des. 2019;25(3):251-297. doi: 10.2174/1381612825666190319114641

32. Zotova NV, Chereshnev VA, Gusev EY. Systemic Inflammation: Methodological Approaches to Identification of the Common Pathological Process. PLoS One. 2016;11(5):e0155138. doi: 10.1371/journal.pone.0155138

33. León-Pedroza JI, González-Tapia LA, del Olmo-Gil E, Castellanos-Rodríguez D, Escobedo G, González-Chávez A. Inflamación sistémica de grado bajo y su relación con el desarrollo de enfermedades metabólicas: de la evidencia molecular a la aplicación clínica [Low-grade systemic inflammation and the development of metabolic diseases: from the molecular evidence to the clinical practice]. Cir Cir. 2015;83(6):543-51. Spanish. doi: 10.1016/j.circir.2015.05.041

34. Buters TP, Hameeteman PW, Jansen IME, van Hindevoort FC, Ten Voorde W, Florencia E, Osse M, de Kam ML, Grievink HW, Schoonakker M, Patel AA, Yona S, Gilroy DW, Lubberts E, Damman J, Feiss G, Rissmann R, Jansen MAA, Burggraaf J, Moerland M. Intradermal lipopolysaccharide challenge as an acute in vivo inflammatory model in healthy volunteers. Br J Clin Pharmacol. 2022;88(2):680-690. doi: 10.1111/bcp.14999

35. Stanhewicz AE, Dillon GA, Serviente C, Alexander LM. Acute systemic inhibition of inflammation augments endothelium-dependent dilation in women with a history of preeclamptic pregnancy. Pregnancy Hypertens. 2022;27:81-86. doi: 10.1016/j.preghy.2021.12.010

36. Rizzoni D, De Ciuceis C, Szczepaniak P, Paradis P, Schiffrin EL, Guzik TJ. Immune System and Microvascular Remodeling in Humans. Hypertension. 2022;79(4):691-705. doi: 10.1161/HYPERTENSIONAHA

37. Everts PA, Malanga GA, Paul RV, Rothenberg JB, Stephens N, Mautner KR. Assessing clinical implications and perspectives of the pathophysiological effects of erythrocytes and plasma free hemoglobin in autologous biologics for use in musculoskeletal regenerative medicine therapies. A review. Regen Ther. 2019;11:56-64. doi: 10.1016/j.reth.2019.03.009

38. Tajima T, Yoshida E, Yamashita A, Ohmura S, Tomitaka Y, Sugiki M, Asada Y, Maruyama M. Hemoglobin stimulates the expression of matrix metalloproteinases, MMP-2 and MMP-9 by synovial cells: a possible cause of joint damage after intra-articular hemorrhage. J Orthop Res. 2005;23(4):891-8. doi: 10.1016/j.orthres.2005.01.003

39. Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J Thromb Haemost. 2010;8(9):1895-902. doi: 10.1111/j.1538-7836.2010.03962.x

40. Morris CJ, Blake DR, Wainwright AC, Steven MM. Relationship between iron deposits and tissue damage in the synovium: an ultrastructural study. Ann Rheum Dis. 1986;45(1):21-6. doi: 10.1136/ard.45.1.21

41. Hooiveld M, Roosendaal G, Vianen M, van den Berg M, Bijlsma J, Lafeber F. Blood-induced joint damage: longterm effects in vitro and in vivo. J Rheumatol. 2003;30(2):339-44.

42. Wei J, Zhao J, Schrott V, Zhang Y, Gladwin M, Bullock G, Zhao Y. Red Blood Cells Store and Release Interleukin-33. J Investig Med. 2015;63(6):806-10. doi: 10.1097/JIM.0000000000000213

43. Karsten E, Hill CJ, Herbert BR. Red blood cells: The primary reservoir of macrophage migration inhibitory factor in whole blood. Cytokine. 2018;102:34-40. doi: 10.1016/j.cyto.2017.12.005

44. Kiliç BA, Kiliç I, Köseoglu MH, Güven C, Demirkan F, Kilinç K. Effects of intra-articular vitamin E and corticosteroid injection in experimental hemarthrosis in rabbits. Pediatr Hematol Oncol. 1998;15(4):339-46. doi: 10.3109/08880019809014018

45. Rogerson FM, Last K, Golub SB, Gauci SJ, Stanton H, Bell KM, Fosang AJ. ADAMTS-9 in Mouse Cartilage Has Aggrecanase Activity That Is Distinct from ADAMTS-4 and ADAMTS-5. Int J Mol Sci. 2019;20(3):573. doi: 10.3390/ijms20030573

46. Swärd P, Frobell R, Englund M, Roos H, Struglics A. Cartilage and bone markers and inflammatory cytokines are increased in synovial fluid in the acute phase of knee injury (hemarthrosis) – a cross-sectional analysis. Osteoarthritis Cartilage. 2012;20(11):1302-8. doi: 10.1016/j.joca.2012.07.021

47. Jansen NW, Roosendaal G, Bijlsma JW, Degroot J, Lafeber FP. Exposure of human cartilage tissue to low concentrations of blood for a short period of time leads to prolonged cartilage damage: an in vitro study. Arthritis Rheum. 2007;56(1):199-207. doi: 10.1002/art.22304

48. Roosendaal G, Vianen ME, van den Berg HM, Lafeber FP, Bijlsma JW. Cartilage damage as a result of hemarthrosis in a human in vitro model. J Rheumatol. 1997;24(7):1350-4.

49. Tajima T, Sekimoto T, Yamaguchi N, Taniguchi N, Kurogi S, Maruyama M, Chosa E. Hemoglobin stimulates the expression of ADAMTS-5 and ADAMTS-9 by synovial cells: a possible cause of articular cartilage damage after intra-articular hemorrhage. BMC Musculoskelet Disord. 2017;18(1):449. doi: 10.1186/s12891-017-1815-7

50. Li L, Zhao D, Chen DF, Zhang ES, Guo SY. Effects of hemarthrosis on cartilage and synovium in rabbits. Eur J Trauma Emerg Surg. 2017;43(2):249-253. doi: 10.1007/s00068-016-0648-7

51. Bileviciute-Ljungar I, Saxne T, Spetea M. Anti-inflammatory effects of contralateral administration of the kappa-opioid agonist U-50,488H in rats with unilaterally induced adjuvant arthritis. Rheumatology (Oxford). 2006;45(3):295-302. doi: 10.1093/rheumatology/kei156

52. Pulles AE, Vøls KK, Christensen KR, Coeleveld K, Hansen AK, van Vulpen LFD, Petersen M, Mastbergen SC, Roepstorff K, Schutgens REG, Kjelgaard-Hansen M, Lafeber FPJG. Proteoglycan synthesis rate as a novel method to measure blood-induced cartilage degeneration in non-haemophilic and haemophilic rats. Haemophilia. 2020;26(3):e88-e96. doi: 10.1111/hae.13969

53. Nieuwenhuizen L, Schutgens RE, Coeleveld K, Mastbergen SC, Roosendaal G, Biesma DH, Lafeber FP. Hemarthrosis in hemophilic mice results in alterations in M1-M2 monocyte/macrophage polarization. Thromb Res. 2014;133(3):390-5. doi: 10.1016/j.thromres.2013.10.039

54. Mulder K, Llinás A. The target joint. Haemophilia. 2004;10 Suppl 4:152-6. doi: 10.1111/j.1365-2516.2004.00976.x

55. Early JO, Fagan LE, Curtis AM, Kennedy OD. Mitochondria in Injury, Inflammation and Disease of Articular Skeletal Joints. Front Immunol. 2021;12:695257. doi: 10.3389/fimmu.2021.695257

56. Hooiveld M, Roosendaal G, Wenting M, van den Berg M, Bijlsma J, Lafeber F. Short-term exposure of cartilage to blood results in chondrocyte apoptosis. Am J Pathol. 2003;162(3):943-51. doi: 10.1016/S0002-9440(10)63889-8

57. Savadipour A, Nims RJ, Katz DB, Guilak F. Regulation of chondrocyte biosynthetic activity by dynamic hydrostatic pressure: the role of TRP channels. Connect Tissue Res. 2022;63(1):69-81. doi: 10.1080/03008207.2020.1871475

58. di Masi A, De Simone G, Ciaccio C, D'Orso S, Coletta M, Ascenzi P. Haptoglobin: From hemoglobin scavenging to human health. Mol Aspects Med. 2020;73:100851. doi: 10.1016/j.mam.2020.100851

59. Pulles AE, van Vulpen LFD, Coeleveld K, Mastbergen SC, Schutgens REG, Lafeber FPJG. On-demand treatment with the iron chelator deferasirox is ineffective in preventing blood-induced joint damage in haemophilic mice. Haemophilia. 2021;27(4):648-656. doi: 10.1111/hae.14328

60. Rzeczycki P, Rasner C, Lammlin L, Junginger L, Goldman S, Bergman R, Redding S, Knights AJ, Elliott M, Maerz T. Cannabinoid receptor type 2 is upregulated in synovium following joint injury and mediates anti-inflammatory effects in synovial fibroblasts and macrophages. Osteoarthritis Cartilage. 2021;29(12):1720-1731. doi: 10.1016/j.joca.2021.09.003

61. Roosendaal G, Vianen ME, Marx JJ, van den Berg HM, Lafeber FP, Bijlsma JW. Blood-induced joint damage: a human in vitro study. Arthritis Rheum. 1999;42(5):1025-32. doi: 10.1002/1529-0131(199905)42:5<1025::AID-ANR23>3.0.CO;2-3

62. Fernandes TL, Gomoll AH, Lattermann C, Hernandez AJ, Bueno DF, Amano MT. Macrophage: A Potential Target on Cartilage Regeneration. Front Immunol. 2020;11:111. doi: 10.3389/fimmu.2020.00111

63. Bonnet N, Garnero P, Ferrari S. Periostin action in bone. Mol Cell Endocrinol. 2016;432:75-82. doi: 10.1016/j.mce.2015.12.014

64. Nakazawa T, Nakajima A, Seki N, Okawa A, Kato M, Moriya H, Amizuka N, Einhorn TA, Yamazaki M. Gene expression of periostin in the early stage of fracture healing detected by cDNA microarray analysis. J Orthop Res. 2004;22(3):520-5. doi: 10.1016/j.orthres.2003.10.007

65. Hu W, Chen Y, Dou C, Dong S. Microenvironment in subchondral bone: predominant regulator for the treatment of osteoarthritis. Ann Rheum Dis. 2021;80(4):413-422. doi: 10.1136/annrheumdis-2020-218089

66. Keret S, Kaly L, Shouval A, Eshed I, Slobodin G. Approach to a patient with monoarticular disease. Autoimmun Rev. 2021;20(7):102848. doi: 10.1016/j.autrev.2021.102848

67. Sanchez-Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol. 2022;18(5):258-275. doi: 10.1038/s41584-022-00749-9

68. Adams SB, Leimer EM, Setton LA, Bell RD, Easley ME, Huebner JL, Stabler TV, Kraus VB, Olson SA, Nettles DL. Inflammatory Microenvironment Persists After Bone Healing in Intra-articular Ankle Fractures. Foot Ankle Int. 2017;38(5):479-484. doi: 10.1177/1071100717690427

69. Kim-Wang SY, Holt AG, McGowan AM, Danyluk ST, Goode AP, Lau BC, Toth AP, Wittstein JR, DeFrate LE, Yi JS, McNulty AL. Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries. Arthritis Res Ther. 2021;23(1):280. doi: 10.1186/s13075-021-02661-1

70. Perry TA, Yang X, van Santen J, Arden NK, Kluzek S. Quantitative and semi-quantitative assessment of synovitis on MRI and the relationship with symptoms in symptomatic knee osteoarthritis. Rheumatology (Oxford). 2021;60(4):1763-1773. doi: 10.1093/rheumatology/keaa619

71. Mohammad M, Hu Z, Ali A, Kopparapu PK, Na M, Jarneborn A, Stroparo MDN, Nguyen MT, Karlsson A, Götz F, Pullerits R, Jin T. The role of Staphylococcus aureus lipoproteins in hematogenous septic arthritis. Sci Rep. 2020;10(1):7936. doi: 10.1038/s41598-020-64879-4

72. Leal-Dos-Santos M, Ferreira JN, Peres D, Palos C. A Thorn in a Haystack: A Rare Case of Septic Arthritis. Cureus. 2021;13(12):e20519. doi: 10.7759/cureus.20519

73. Bartlett SI, Dreyer MA. Ankle Arthrocentesis. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

74. Liang SX, Wang HL, Zhang PP, Shen J, Yang K, Meng L, Liu H, Yan YB. Differential regulation of blood vessel formation between traumatic temporomandibular joint fibrous ankylosis and bony ankylosis in a sheep model. J Craniomaxillofac Surg. 2019;47(11):1739-1751. doi: 10.1016/j.jcms.2019.07.032

75. Caviglia H, Daffunchio C, Galatro G, Cambiaggi G, Oneto P, Douglas Price AL, Landro ME, Etulain J. Inhibition of Fenton reaction is a novel mechanism to explain the therapeutic effect of intra-articular injection of PRP in patients with chronic haemophilic synovitis. Haemophilia. 2020;26(4):e187-e193. doi: 10.1111/hae.14075

76. Oneto P, Landro ME, Daffunchio C, Douglas Price AL, Carrera Silva EA, Caviglia H, Etulain J. DNA extracellular traps as potential biomarker of chronic haemophilic synovitis and therapeutic perspective in patients treated with PRP: A pilot study. Haemophilia. 2022;28(2):351-361. doi: 10.1111/hae.14508

77. Lyons LP, Weinberg JB, Wittstein JR, McNulty AL. Blood in the joint: effects of hemarthrosis on meniscus health and repair techniques. Osteoarthritis Cartilage. 2021;29(4):471-479. doi: 10.1016/j.joca.2020.11.008

78. Heard BJ, Barton KI, Agbojo OM, Chung M, Sevick JL, Bader TJ, Martin CR, Shrive NG, Hart DA. Molecular Response of Rabbit Menisci to Surgically Induced Hemarthrosis and a Single Intra-Articular Dexamethasone Treatment. J Orthop Res. 2019;37(9):2043-2052. doi: 10.1002/jor.24346

79. Puebla DL, Farrow RA. Ultrasound Guided Arthrocentesis. 2022 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

80. Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol. 2013;27(2):137-69. doi: 10.1016/j.berh.2013.02.005