İnfrapatellar Yağ Yastığı ve Diz Eklemi Osteoartriti
Özet
İnfrapatellar yağ yastığı (İPYY), diz ekleminde hem biyomekanik hem de endokrinolojik rollere sahip olan ve patogenezi henüz tam olarak anlaşılamamış diz eklemi osteoartritinde (OA) anahtar rol oynayan aktif bir dokudur. Anatomik olarak eklem içi ancak ekstrasinovyal yerleşimli olan İPYY; zengin bir vasküler ağa ve Substans P ile CGRP pozitif sinir liflerinden oluşan yoğun bir duyusal inervasyona sahiptir; bu özellikleri nedeniyle ön diz ağrısının ve nörojenik inflamasyonun birincil kaynaklarından biri olarak kabul edilir. Obezite ve yaşlanma süreçlerinde metabolik ve hücresel düzeyde tetiklenen İPYY; IL-1β, IL-6, TNF-α gibi pro-inflamatuar sitokinler ile leptin ve adiponektin gibi adipokinleri doğrudan sinovyal sıvıya salgılayarak eklem kıkırdağı yıkımını, subkondral kemik sklerozunu, menisküs ve bağ dejenerasyonunu sinerjik olarak hızlandırır. Buna karşılık İPYY, yüksek proliferasyon ve üstün kondrojenik farklılaşma kapasitesine sahip zengin mezenkimal kök hücre (MKH) içeriğiyle, rejeneratif tıp çalışmalarında fokal kıkırdak hasarlarının hücresel tedavisinde güçlü ve kolay erişilebilir anabolik bir kaynak sunar. Total diz artroplastisi (TDA) cerrahisinde ise görüş alanını artırmak amacıyla İPYY'nin eksize edilmesi veya korunması konusu halen tartışmalıdır; literatürde eksizyonun diz önü ağrısı, patellar tendon kısalması ve patella vaskülarizasyonu üzerindeki etkilerine dair çelişkili klinik sonuçlar bulunmakla birlikte, eklem hareket açıklığı ve fonksiyonel skorlarda gruplar arasında genellikle anlamlı bir fark saptanmamıştır. Sonuç olarak İPYY, basit bir mekanik koruyucu yastık olmanın ötesinde, diz osteoartritinin hem ilerlemesinde hem de hücresel tedavisinde çift yönlü işlevi olan metabolik bir organdır.
The infrapatellar fat pad (IPFP) is an active tissue that plays a key role in knee joint osteoarthritis (OA), a disease whose pathogenesis is not yet fully understood, and possesses both biomechanical and endocrinological roles in the knee joint. Anatomically intracapsular but extrasynovial, the IPFP has a rich vascular network and dense sensory innervation consisting of Substance P and CGRP positive nerve fibers; due to these features, it is considered one of the primary sources of anterior knee pain and neurogenic inflammation. Triggered at the metabolic and cellular level during obesity and aging processes, the IPFP secretes pro-inflammatory cytokines such as IL-1β, IL-6, TNF-α, and adipokines like leptin and adiponectin directly into the synovial fluid, synergistically accelerating articular cartilage destruction, subchondral bone sclerosis, and meniscus and ligament degeneration. Conversely, with its rich mesenchymal stem cell (MSC) content having high proliferation and superior chondrogenic differentiation capacity, the IPFP offers a potent and easily accessible anabolic source for the cellular treatment of focal cartilage defects in regenerative medicine studies. In total knee arthroplasty (TKA) surgery, the excision or preservation of the IPFP to increase the surgical field is still controversial; although the literature presents conflicting clinical results regarding the effects of excision on anterior knee pain, patellar tendon shortening, and patellar vascularization, no significant difference is generally detected between the groups in terms of range of motion and functional scores. In conclusion, beyond being a simple mechanical protective cushion, the IPFP is a metabolic organ with a dual function in both the progression and cellular treatment of knee osteoarthritis.
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