OBJECTIVE 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 ex vivo impacting of osteochondral autografts results in higher chondrocyte matrix production versus intact osteochondral autograft plugs. DESIGN 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. RESULTS 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 (P = 0.015 and P = 0.021). qRT-PCR analysis yielded a significant (P = 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. CONCLUSIONS 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.

中文翻译：

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骨软骨自体移植物塞与糊状移植物：离体粉碎增加软骨基质生产。

目的 研究表明，接受关节软骨糊剂移植的患者在长期随访中的疼痛和功能有显着改善。我们假设自体骨软骨移植物的离体影响导致软骨细胞基质产生高于完整的自体骨软骨移植物栓塞。设计 这项经机构审查委员会批准的研究描述了将 16 名患者髁间切迹收获的骨软骨栓撞击成糊状的效果，留下一个完整的移植物作为对照。在 24 和 48 小时通过 qRT-PCR（定量逆转录聚合酶链反应）分析细胞活力/增殖、I/II 型胶原蛋白、SOX-9 和聚集蛋白聚糖基因表达。使用组织学评估基质产生和细胞形态。结果 中度 (19%) 至重度 (81%) 软骨损伤患者（平均年龄 39.7 岁）的糊状样品在处理后 24 小时和 48 小时时的细胞增殖率分别比栓塞高出 34% 和 80%（P = 0.015 和P = 0.021）。qRT-PCR 分析在 24 和 48 小时均产生了蛋白聚糖、SOX-9、I 型和 II 型胶原蛋白的显着增加 (P = 0.000)。组织学检查显示整个糊状样品中的细胞分裂，在多个软骨细胞腔周围聚集聚集蛋白聚糖。结论 糊状移植物制剂通过基质破坏导致软骨细胞的流动性增加，而不会丧失细胞活力。撞击程序刺激软骨细胞增殖，导致细胞反应以重建天然细胞外基质。基因表达分析支持软骨组织形成的再生过程，并与长期以来认为撞击创伤导致细胞立即死亡的信念相矛盾。这种作用机制转化为中度至重度软骨损伤患者的临床益处。