Feinstein Institute for Medical Research, Manhasset, NY, USA.
Stone Research Foundation, San Francisco, CA, USA.
Cartilage. 2021 Dec;13(1_suppl):1058S-1065S. doi: 10.1177/1947603520916552. Epub 2020 May 12.
Patients undergoing articular cartilage paste grafting have been shown in studies to have significant improvement in pain and function in long-term follow-ups. We hypothesized that impacting of osteochondral autografts results in higher chondrocyte matrix production versus intact osteochondral autograft plugs.
This institutional review board-approved study characterizes the effects of impacting osteochondral plugs harvested from the intercondylar notch of 16 patients into a paste, leaving one graft intact as a control. Cell viability/proliferation, collagen type I/II, SOX-9, and aggrecan gene expression via qRT-PCR (quantitative reverse transcription-polymerase chain reaction) were analyzed at 24 and 48 hours. Matrix production and cell morphology were evaluated using histology.
Paste samples from patients (mean age 39.7) with moderate (19%) to severe (81%) cartilage lesions displayed 34% and 80% greater cell proliferation compared to plugs at 24 and 48 hours post processing, respectively ( = 0.015 and = 0.021). qRT-PCR analysis yielded a significant ( = 0.000) increase of aggrecan, SOX-9, collagen type I and II at both 24 and 48 hours. Histological examination displayed cell division throughout paste samples, with accumulation of aggrecan around multiple chondrocyte lacunae.
Paste graft preparation resulted in increased mobility of chondrocytes by matrix disruption without loss of cell viability. The impaction procedure stimulated chondrocyte proliferation resulting in a cellular response to reestablish native extracellular matrix. Analysis of gene expression supports a regenerative process of cartilage tissue formation and contradicts long-held beliefs that impaction trauma leads to immediate cell death. This mechanism of action translates into clinical benefit for patients with moderate to severe cartilage damage.
研究表明，接受关节软骨糊状物移植的患者在长期随访中疼痛和功能有显著改善。我们假设，与完整的骨软骨自体移植物塞相比，撞击骨软骨移植物会导致更高的软骨细胞基质产生。
这项经机构审查委员会批准的研究从 16 名患者的髁间窝中采集的骨软骨塞进行撞击，制成糊状物，同时留下一个移植物作为对照，以确定其特征。通过 qRT-PCR（定量逆转录聚合酶链反应）分析细胞活力/增殖、胶原 I/II、SOX-9 和聚集蛋白聚糖基因表达，分别在 24 小时和 48 小时进行分析。通过组织学评估基质产生和细胞形态。
来自有中度（19%）至重度（81%）软骨损伤的患者（平均年龄 39.7 岁）的糊状物样本在处理后 24 小时和 48 小时时细胞增殖分别增加了 34%和 80%，与塞子相比（=0.015 和=0.021）。qRT-PCR 分析在 24 小时和 48 小时均显示聚集蛋白聚糖、SOX-9、胶原 I 和 II 显著增加（=0.000）。组织学检查显示糊状物样本中存在细胞分裂，在多个软骨细胞陷窝周围聚集蛋白聚糖积累。
糊状物移植物制备通过基质破坏使软骨细胞移动性增加，而不损失细胞活力。撞击过程刺激软骨细胞增殖，导致细胞反应以重建固有细胞外基质。基因表达分析支持软骨组织形成的再生过程，这与长期以来认为撞击创伤会导致立即细胞死亡的观点相矛盾。这种作用机制为有中度至重度软骨损伤的患者带来了临床益处。
