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1. General Principles & Basic Science MCQs

Practice Set 501 of 789

This practice set contains high-yield board review questions covering key concepts in 1. General Principles & Basic Science. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 10001

Topic: 1. General Principles & Basic Science

Which specific type of nerve injury, according to Sunderland's classification, is characterized by damage to the axon and endoneurium, but preservation of the perineurium and epineurium, leading to a good prognosis for recovery due to preserved architectural scaffolding?

. First-degree (Neuropraxia)
. Second-degree (Axonotmesis)
. Third-degree
. Fourth-degree
. Fifth-degree (Neurotmesis)

Correct Answer & Explanation

. Second-degree (Axonotmesis)

Explanation

Sunderland's classification expands on Seddon's classification. A second-degree nerve injury (Axonotmesis) involves damage to the axon and the myelin sheath, as well as the endoneurium, but critically, the perineurium and epineurium remain intact. This preservation of the connective tissue scaffolding provides a clear path for regenerating axons to grow distally, leading to a good prognosis for functional recovery, albeit often incomplete and requiring time for axonal regrowth. First-degree (Neuropraxia) involves only demyelination, with full recovery. Third-degree involves damage to axon, endoneurium, and perineurium (with internal disorganization), leading to less predictable recovery. Fourth-degree involves damage to axon, endoneurium, perineurium, and partial epineurium, with a poor prognosis without surgery. Fifth-degree (Neurotmesis) involves complete transection of the nerve, requiring surgical repair for any meaningful recovery.

Question 10002

Topic: Biology, Genetics & Bone Healing
In the context of bone remodeling and osteoporosis treatment, the drug Denosumab targets which specific component of the RANK/RANKL/OPG pathway?
. Stimulates osteoprotegerin (OPG) production
. Inhibits RANK receptor on osteoclasts/precursors
. Acts as a synthetic parathyroid hormone (PTH) analog
. Directly stimulates Wnt/β-catenin signaling
. Binds to and neutralizes RANKL

Correct Answer & Explanation

. Binds to and neutralizes RANKL

Explanation

Denosumab is a fully human monoclonal antibody that specifically targets and binds to Receptor Activator of Nuclear Factor kappa-Β Ligand (RANKL). By binding to RANKL, Denosumab prevents RANKL from binding to its receptor (RANK) on the surface of osteoclast precursors and mature osteoclasts. This inhibition prevents osteoclast formation, function, and survival, leading to a significant reduction in bone resorption. It does not stimulate OPG production, nor does it inhibit the RANK receptor directly (it inhibits its ligand). It is not a PTH analog and does not directly stimulate Wnt/β-catenin signaling.

Question 10003

Topic: Biology, Genetics & Bone Healing
In cartilage tissue engineering, mesenchymal stem cells (MSCs) are often cultured in specific media. Which combination of growth factors and conditions is typically most effective for chondrogenic differentiation of MSCs?
. High oxygen tension and high levels of VEGF
. TGF-β3, Dexamethasone, and Insulin-Transferrin-Selenium (ITS) under hypoxic conditions
. BMP-2 and FGF-2 with serum supplementation
. IL-1β and TNF-α to promote inflammation
. High glucose and high sodium chloride concentrations

Correct Answer & Explanation

. TGF-β3, Dexamethasone, and Insulin-Transferrin-Selenium (ITS) under hypoxic conditions

Explanation

For optimal chondrogenic differentiation of mesenchymal stem cells (MSCs) in vitro, a specific cocktail of growth factors and culture conditions is essential. Transforming Growth Factor-beta 3 (TGF-β3) is a potent inducer of chondrogenesis. Dexamethasone promotes chondrogenesis and stabilizes chondrocyte phenotype. Insulin-Transferrin-Selenium (ITS) provides essential nutrients and growth factors. Furthermore, hypoxic conditions (low oxygen tension) are crucial as cartilage is naturally an avascular and hypoxic tissue, and hypoxia enhances chondrogenic gene expression. High oxygen tension and VEGF would promote vascularization and inhibit chondrogenesis. BMP-2 and FGF-2 are more involved in bone formation/proliferation. IL-1β and TNF-α are pro-inflammatory and catabolic to cartilage. High glucose and high sodium are not specific chondrogenic conditions.

Question 10004

Topic: Biology, Genetics & Bone Healing

A patient undergoing complex fracture healing is found to have delayed union. From a cellular perspective, what is a primary contributing factor to delayed or non-union, even with adequate fixation?

. Excessive and uncontrolled osteoclast activity without osteoblast compensation
. Persistent instability and inadequate mechanical loading at the fracture site
. Insufficient number or activity of mesenchymal stem cells and osteoprogenitor cells at the injury site
. Overexpression of bone morphogenetic proteins (BMPs) leading to heterotopic ossification
. Premature differentiation of chondrocytes into osteocytes

Correct Answer & Explanation

. Insufficient number or activity of mesenchymal stem cells and osteoprogenitor cells at the injury site

Explanation

While persistent instability and inadequate mechanical loading are significant causes of delayed union or non-union (mechanical factors), the question asks for a 'cellular perspective.' A primary cellular contributing factor to delayed union or non-union is an insufficient number or impaired activity of mesenchymal stem cells and osteoprogenitor cells at the injury site. These cells are crucial for callus formation and bone regeneration. Without an adequate pool of these cells or their proper function (e.g., due to local tissue damage, systemic disease, or age), the biological capacity for healing is compromised. Excessive osteoclast activity might contribute but is not the sole primary factor. Overexpression of BMPs typically promotes healing, not impedes it, though excessive can cause HO. Premature differentiation of chondrocytes into osteocytes is not the primary cellular cause of delayed union.

Question 10005

Topic: Biology, Genetics & Bone Healing

Which feature of cancellous bone makes it particularly suitable for integration with porous-coated orthopedic implants through osseointegration?

. Its high cortical bone density and strength
. Its abundant blood supply and large surface area for cellular infiltration
. Its compact arrangement of Haversian systems
. Its relative avascularity, preventing inflammatory responses
. Its primary composition of Type I collagen without a mineralized matrix

Correct Answer & Explanation

. Its abundant blood supply and large surface area for cellular infiltration

Explanation

Cancellous bone (also known as spongy or trabecular bone) is highly vascularized and has a large internal surface area due to its porous, trabecular structure. This structure allows for excellent blood supply and facilitates the infiltration of osteoprogenitor cells, fibroblasts, and blood vessels from the host bone into the porous coating of an implant. This rich cellular and vascular environment is critical for promoting osseointegration, where new bone grows directly onto or into the implant surface, establishing a strong biological fixation. Cortical bone is dense and strong but has a different structure. Haversian systems are characteristic of cortical bone. Avascularity would impede integration, and cancellous bone is well-vascularized. Cancellous bone has a mineralized matrix, like all bone.

Question 10006

Topic: Biology, Genetics & Bone Healing

In patients with diabetic neuropathy, which of the following mechanisms best explains the predisposition to Charcot neuroarthropathy?

. Direct inflammatory destruction of cartilage due to hyperglycemia
. Increased bone density and reduced bone turnover, making bone brittle
. Loss of protective sensation combined with autonomic neuropathy leading to abnormal vascular responses and bone remodeling
. Hyperactivity of osteoblasts causing excessive bone formation and joint fusion
. Direct bacterial infection of the joint capsule due to impaired immune response

Correct Answer & Explanation

. Loss of protective sensation combined with autonomic neuropathy leading to abnormal vascular responses and bone remodeling

Explanation

Charcot neuroarthropathy is a severe, progressive degenerative arthritis resulting from underlying neuropathy, most commonly diabetic neuropathy. The pathophysiology is complex, but the 'neurotraumatic' theory and 'neurovascular' theory are key. The loss of protective sensation (due to peripheral neuropathy) prevents the patient from sensing microtrauma and pain, leading to repetitive injuries and continued weight-bearing on an insensate foot. Autonomic neuropathy leads to abnormal vascular responses (vasodilation), increased blood flow, and altered local bone metabolism, promoting osteoclastic activity and bone resorption, further weakening the bone. This combination leads to progressive joint destruction, dislocation, and deformity. It's not primarily direct inflammatory destruction, increased bone density (rather, it causes bone resorption), hyperactivity of osteoblasts, or direct bacterial infection (though infection can be a secondary complication).

Question 10007

Topic: Biology, Genetics & Bone Healing

During fracture healing, the initial soft callus formation is predominantly composed of which type of tissue?

. Lamellar bone
. Fibrous connective tissue and hyaline cartilage
. Adipose tissue and skeletal muscle
. Woven bone directly formed by osteoblasts
. Dense regular connective tissue resembling tendon

Correct Answer & Explanation

. Fibrous connective tissue and hyaline cartilage

Explanation

Fracture healing proceeds through several stages. Following hematoma formation and inflammation, the soft callus stage begins. In this stage, mesenchymal stem cells migrate to the fracture site and differentiate into fibroblasts and chondrocytes. Fibroblasts produce a fibrous connective tissue, and chondrocytes form hyaline cartilage, creating a bridge across the fracture gap. This soft callus provides initial stability but is not yet rigid. This soft callus is then gradually mineralized and replaced by woven bone, which is then remodeled into lamellar bone. Lamellar bone is formed later during remodeling. Adipose tissue and muscle are not the primary components. Woven bone forms later by endochondral ossification (replacing cartilage) and intramembranous ossification.

Question 10008

Topic: Biology, Genetics & Bone Healing

Which of the following describes the 'creeping substitution' phenomenon observed in allograft bone incorporation?

. The gradual wear of the allograft due to mechanical friction
. The slow degradation of the allograft by host osteoclasts, followed by new bone formation by host osteoblasts
. The rapid calcification of the allograft material within weeks of implantation
. The process of immunological rejection leading to graft necrosis
. The absorption of fluid by the allograft, causing it to swell and integrate

Correct Answer & Explanation

. The slow degradation of the allograft by host osteoclasts, followed by new bone formation by host osteoblasts

Explanation

Creeping substitution is the hallmark process of revascularization, resorption, and new bone formation that occurs when an allograft (or autograft) is implanted. Host osteoclasts slowly resorb the non-viable donor bone matrix, creating space for blood vessels and osteoprogenitor cells to invade. Subsequently, host osteoblasts deposit new viable bone onto the remaining scaffold of the donor bone. This is a slow, gradual process that can take many months to years. It is not about wear, rapid calcification, immunological rejection (which is typically minimal with processed allografts), or fluid absorption leading to swelling.

Question 10009

Topic: Biology, Genetics & Bone Healing
A 65-year-old female presents with osteoporosis. She is being considered for an anabolic agent that targets the Wnt/β-catenin signaling pathway. This class of drugs typically functions by inhibiting a specific protein that normally suppresses osteoblast activity. Which of the following proteins is the primary target for such anabolic agents in bone?
. RANKL
. Osteoprotegerin (OPG)
. Sclerostin
. Dickkopf-1 (DKK-1)
. Parathyroid Hormone-Related Protein (PTHrP)

Correct Answer & Explanation

. Sclerostin

Explanation

Sclerostin, produced by osteocytes, is a potent inhibitor of the Wnt/β-catenin pathway, which is critical for osteoblast differentiation and function. By binding to LRP5/6 co-receptors, sclerostin prevents Wnt ligand binding, thus suppressing bone formation. Anti-sclerostin antibodies (e.g., Romosozumab) are a class of anabolic agents that block sclerostin, leading to increased bone formation and, to a lesser extent, decreased bone resorption. RANKL promotes osteoclast differentiation. OPG inhibits RANKL. DKK-1 is another Wnt antagonist but is not the primary target of currently approved anabolic agents in this context. PTHrP is involved in endochondral ossification and calcium homeostasis, distinct from the primary mechanism of sclerostin.

Question 10010

Topic: 1. General Principles & Basic Science
Chondrocytes respond to mechanical loads, a process known as mechanotransduction, which is crucial for maintaining cartilage homeostasis. Which of the following is considered a primary mechanoreceptor or mechanosensitive pathway in articular chondrocytes that translates mechanical stimuli into biochemical signals?
. Toll-like receptors (TLRs)
. Transient Receptor Potential Vanilloid 4 (TRPV4) channels
. G protein-coupled receptors (GPCRs)
. Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)
. Epidermal Growth Factor Receptors (EGFRs)

Correct Answer & Explanation

. Transient Receptor Potential Vanilloid 4 (TRPV4) channels

Explanation

TRPV4 channels are well-established calcium-permeable ion channels that act as important mechanoreceptors in articular chondrocytes. They detect osmotic changes and mechanical stress, leading to intracellular calcium influx and subsequent signaling cascades that regulate gene expression, matrix synthesis, and catabolism. While other pathways (like NF-κB) can be activated downstream, and GPCRs/EGFRs are involved in various cellular processes, TRPV4 is recognized as a direct and crucial mechanosensor in chondrocytes. TLRs are primarily involved in immune responses.

Question 10011

Topic: Biology, Genetics & Bone Healing

For successful osseointegration of a titanium implant, a critical biological process involves the initial adsorption of host proteins onto the implant surface, which then dictates subsequent cellular responses. Which of the following protein types is most crucial for mediating initial osteoblast adhesion and differentiation on a clean titanium surface?

. Immunoglobulins
. Fibrinogen
. Albumin
. Fibronectin and Vitronectin
. Glycosaminoglycans (GAGs)

Correct Answer & Explanation

. Fibronectin and Vitronectin

Explanation

Fibronectin and Vitronectin are adhesive glycoproteins found in plasma and the extracellular matrix. They rapidly adsorb onto implant surfaces and provide specific binding sites (e.g., RGD sequences) for cell surface integrins on osteoblasts. This initial binding is crucial for mediating osteoblast adhesion, spreading, proliferation, and differentiation, forming the basis for subsequent bone apposition and osseointegration. While fibrinogen is also an early adsorbate and involved in clot formation, and albumin is abundant, fibronectin and vitronectin are specifically recognized for their role in promoting osteoblast attachment. Immunoglobulins are more related to immune responses. GAGs are matrix components, not typically primary adsorbing proteins for initial cell adhesion in this context.

Question 10012

Topic: Biology, Genetics & Bone Healing
A patient develops an atrophic non-union following a tibia fracture. Which of the following molecular profiles is most consistent with an atrophic non-union, reflecting a failure of the biological processes necessary for bone formation?
. High levels of VEGF and BMP-2
. Low levels of SOX9 and Type II collagen
. Decreased local angiogenesis and reduced expression of osteogenic markers
. Increased expression of aggrecanases (ADAMTS) and MMPs
. Elevated levels of pro-inflammatory cytokines like TNF-α and IL-1β with minimal osteogenic activity

Correct Answer & Explanation

. Decreased local angiogenesis and reduced expression of osteogenic markers

Explanation

Atrophic non-unions are characterized by insufficient biological activity, often stemming from poor vascularity and a lack of osteogenic cells. This leads to decreased local angiogenesis (reduced blood supply) and a diminished capacity for new bone formation, manifesting as reduced expression of osteogenic markers (e.g., osteocalcin, alkaline phosphatase, Type I collagen). While some inflammation (e.g., TNF-α, IL-1β) might be present, the defining feature of atrophic non-union is the lack of biological potential, rather than excessive catabolism (as might be seen with aggrecanases/MMPs in hypertrophic non-unions or highly inflammatory states) or exuberant osteogenic activity. High VEGF and BMP-2 would typically promote healing. SOX9 and Type II collagen are markers for cartilage, which is important in endochondral healing, but low levels wouldn't be the primary defining feature for atrophic non-union of bone itself.

Question 10013

Topic: Infection, Pharmacology & VTE

A patient develops a chronic periprosthetic joint infection (PJI) resistant to conventional antibiotic therapy. The persistence of the infection is largely attributed to the formation of a bacterial biofilm on the implant surface. Which component of the biofilm matrix is primarily responsible for protecting bacteria from host immune defenses and antibiotics, contributing to treatment failure?

. Peptidoglycan layer
. Lipopolysaccharide (LPS)
. Exopolysaccharide (EPS) matrix
. Flagella
. Outer membrane proteins

Correct Answer & Explanation

. Exopolysaccharide (EPS) matrix

Explanation

The exopolysaccharide (EPS) matrix, also known as the extracellular polymeric substance, is the major component of bacterial biofilms. It forms a protective barrier that encapsulates bacteria, preventing penetration of antibiotics, shielding them from host immune cells (e.g., phagocytes), and facilitating adhesion to surfaces. This matrix is critical for biofilm resistance and the chronicity of PJI. Peptidoglycan and LPS are components of the bacterial cell wall (gram-positive and gram-negative, respectively) but are not the primary protective elements of the biofilmmatrix. Flagella are for motility, and outer membrane proteins are involved in various functions but not the main protective matrix.

Question 10014

Topic: Biomechanics & Biomaterials

During rapid movements, ligaments exhibit different mechanical properties compared to slow, sustained loading. This characteristic, where the mechanical response of a material depends on the rate of loading, is known as:

. Anisotropy
. Isotropy
. Viscoelasticity
. Elasticity
. Plasticity

Correct Answer & Explanation

. Viscoelasticity

Explanation

Viscoelasticity describes materials that exhibit both viscous (fluid-like) and elastic (solid-like) properties. Biological tissues like ligaments and tendons are viscoelastic, meaning their stress-strain relationship is time-dependent. They become stiffer and stronger when loaded rapidly (rate-dependent stiffness) and can exhibit creep (increasing deformation under constant load) and stress relaxation (decreasing stress over time under constant deformation). Anisotropy means properties vary with direction. Isotropy means properties are uniform in all directions. Elasticity refers to the ability to return to original shape after deformation, and plasticity refers to permanent deformation, neither fully capturing the time-dependent nature.

Question 10015

Topic: Biology, Genetics & Bone Healing

A defect in the maturation of chondrocytes, leading to their failure to hypertrophy and undergo apoptosis, would primarily affect which specific zone of the epiphyseal growth plate, potentially resulting in impaired longitudinal bone growth?

. Reserve zone
. Proliferative zone
. Hypertrophic zone
. Zone of calcified cartilage
. Zone of primary spongiosa

Correct Answer & Explanation

. Hypertrophic zone

Explanation

The hypertrophic zone is where chondrocytes enlarge significantly, accumulate lipids and glycogen, and prepare for apoptosis and subsequent replacement by bone. Failure of chondrocytes to hypertrophy and undergo apoptosis directly impairs the critical steps for endochondral ossification within this zone. The reserve zone stores chondrocytes, the proliferative zone is for cell division, the zone of calcified cartilage is where the matrix calcifies before osteoblast invasion, and the primary spongiosa is where bone deposition begins. A defect in hypertrophy directly impacts the hypertrophic zone's function.

Question 10016

Topic: Biology, Genetics & Bone Healing

In patients with uncontrolled Type 2 Diabetes Mellitus, fracture healing is often delayed or compromised. Which of the following is a primary molecular mechanism by which hyperglycemia and diabetic complications impair bone repair?

. Decreased circulating levels of Parathyroid Hormone (PTH)
. Reduced formation of Advanced Glycation End-products (AGEs)
. Impaired angiogenesis and osteoblast function due to altered Wnt signaling and oxidative stress
. Enhanced osteoclast activity and increased bone density
. Increased production of insulin-like growth factor 1 (IGF-1) stimulating osteogenesis

Correct Answer & Explanation

. Impaired angiogenesis and osteoblast function due to altered Wnt signaling and oxidative stress

Explanation

Chronic hyperglycemia in diabetes leads to the formation of Advanced Glycation End-products (AGEs), increased oxidative stress, and microvascular complications. These factors collectively impair angiogenesis (blood vessel formation) and directly inhibit osteoblast differentiation and function. There's also evidence of altered Wnt signaling (a crucial pathway for bone formation) and reduced growth factor bioavailability (e.g., IGF-1 can be reduced or its signaling impaired). Far from promoting healing, these pathways contribute to delayed union, non-union, and reduced bone quality. Decreased PTH is not a primary mechanism. Reduced AGEs would be beneficial. Enhanced osteoclast activity would cause bone loss, and increased bone density is not typical for diabetic bone. Increased IGF-1 stimulating osteogenesis is contrary to the observed impaired healing.

Question 10017

Topic: Biology, Genetics & Bone Healing

In recent years, marrow adipose tissue (MAT) has been recognized as an active component of the bone microenvironment, beyond simple passive fat storage. Which of the following statements best describes a role of MAT in bone health and disease?

. MAT primarily acts as an endocrine gland, secreting pro-osteogenic factors that directly stimulate osteoblast differentiation
. High MAT content is consistently associated with increased bone mineral density and improved fracture healing outcomes
. MAT can compete with hematopoietic stem cells and osteoblast precursors for niche space and resources, particularly in conditions like osteoporosis
. MAT is metabolically inert and serves only as a structural filler within the bone marrow cavity
. MAT is the primary source of sclerostin, regulating Wnt signaling in bone.

Correct Answer & Explanation

. MAT can compete with hematopoietic stem cells and osteoblast precursors for niche space and resources, particularly in conditions like osteoporosis

Explanation

MAT is a dynamic tissue. While it can secrete adipokines, its role is complex. In conditions like osteoporosis, aging, and certain metabolic diseases, there is an increase in MAT. This expansion of MAT is often associated with a decrease in hematopoietic stem cells and osteoblast precursors, suggesting competition for the limited bone marrow niche. High MAT content is generally associated with lower bone mineral density and impaired bone formation/healing, not improved outcomes. MAT is metabolically active, not inert. Osteocytes, not MAT, are the primary source of sclerostin.

Question 10018

Topic: Biology, Genetics & Bone Healing

Recombinant human BMP-2 (rhBMP-2) is used clinically to promote bone healing. However, a known side effect, particularly in spinal fusion procedures, is the risk of ectopic bone formation. Which of the following best explains the mechanism behind this undesirable effect?

. BMP-2's exclusive differentiation pathway towards osteoclasts
. Non-specific activation of mesenchymal stem cells (MSCs) present in surrounding soft tissues to differentiate into osteoblasts
. Direct transformation of mature fibroblasts into osteocytes
. Inhibition of angiogenesis leading to aberrant cartilage formation
. Systemic absorption of BMP-2 causing widespread calcification.

Correct Answer & Explanation

. Non-specific activation of mesenchymal stem cells (MSCs) present in surrounding soft tissues to differentiate into osteoblasts

Explanation

BMP-2 is a potent osteoinductive factor, meaning it can induce mesenchymal stem cells (MSCs) to differentiate along an osteogenic pathway. When applied in high concentrations, especially in soft tissue environments adjacent to the intended fusion site, it can activate resident MSCs in those soft tissues (e.g., muscle, fascia) to form bone ectopically. BMP-2 promotes osteoblast differentiation, not osteoclast. It doesn't directly transform mature fibroblasts into osteocytes. It promotes angiogenesis, not inhibits it. While some systemic absorption can occur, the primary mechanism of ectopic bone formation is localized, non-specific induction of MSCs.

Question 10019

Topic: Biology, Genetics & Bone Healing
A patient develops aseptic loosening of a total knee arthroplasty component several years post-implantation. Histological analysis of the periprosthetic tissue reveals numerous macrophages engulfing polyethylene particles and abundant inflammatory cells. This phenomenon, leading to bone resorption and implant loosening, is primarily mediated by which of the following cellular pathways?
. Direct mechanical failure of the implant-bone interface
. Immune-mediated activation of osteoclasts through the RANKL/RANK/OPG pathway
. Formation of a dense fibrous capsule isolating the implant
. Accelerated chondrocyte apoptosis due to metal ion toxicity
. Bacterial biofilm formation on the implant surface

Correct Answer & Explanation

. Immune-mediated activation of osteoclasts through the RANKL/RANK/OPG pathway

Explanation

Aseptic loosening due to wear debris (e.g., polyethylene, metal) is a major cause of late implant failure. Macrophages phagocytose these particles and become activated, releasing a cascade of pro-inflammatory cytokines (e.g., TNF-α, IL-1, IL-6) and prostaglandins. These inflammatory mediators then stimulate fibroblasts and other cells in the periprosthetic membrane to express high levels of RANKL (Receptor Activator of Nuclear factor Kappa-Β Ligand) and downregulate OPG (Osteoprotegerin). The increased RANKL/OPG ratio potently activates osteoclasts, leading to periprosthetic osteolysis and subsequent implant loosening. While mechanical failure can occur, osteolysis is a key biological mechanism of aseptic loosening.

Question 10020

Topic: 1. General Principles & Basic Science

Autologous Chondrocyte Implantation (ACI) is a technique used for repairing full-thickness cartilage defects. The success of ACI relies on the ability of the implanted cells to regenerate hyaline-like cartilage. What is the most critical characteristic of the chondrocytes isolated for ACI that contributes to this regenerative capacity, which can be lost during extended in vitro expansion?

. High expression of Type I collagen
. Retention of a chondrogenic phenotype and synthesis of Type II collagen and aggrecan
. High migratory potential to cover the defect rapidly
. Low metabolic activity to minimize immune rejection
. Ability to form a functional perichondrial ring.

Correct Answer & Explanation

. Retention of a chondrogenic phenotype and synthesis of Type II collagen and aggrecan

Explanation

The goal of ACI is to regenerate hyaline cartilage. Healthy articular chondrocytes primarily synthesize Type II collagen and aggrecan, key components of hyaline cartilage extracellular matrix. During in vitro expansion, especially prolonged culture, chondrocytes can undergo 'dedifferentiation,' shifting towards a fibroblastic phenotype, characterized by increased Type I collagen synthesis and reduced Type II collagen and aggrecan production. Maintaining a stable chondrogenic phenotype capable of producing hyaline-like matrix is crucial for ACI success. Type I collagen is associated with fibrous tissue, not hyaline cartilage. Migratory potential and immune rejection (autologous cells have low rejection risk) are less critical than phenotypic stability.

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