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Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full thickness defects in joint surfaces under the influence of continuous passive motion



Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full thickness defects in joint surfaces under the influence of continuous passive motion



Journal of Bone & Joint Surgery American Volume 70(4): 595-606



an autogenous graft of tibial periosteum was sutured (with its cambium layer facing into the joint) to the base of a five by ten-millimeter full-thickness defect in the patellar groove of each of forty-five adolescent rabbits. The rabbits were randomly treated postoperatively by either four weeks of immobilization in a cast, intermittent active motion in a cage, or two weeks of continuous passive motion. One year postoperatively, the regenerated tissue from each rabbit was analyzed macroscopically, histologically, histochemically, and biochemically. Gross degenerative changes were seen in 57 per cent of the rabbits that had been immobilized in a cast, in 73 per cent of the rabbits that had been allowed intermittent active motion, and in 22 per cent of the rabbits that had been subjected to continuous passive motion (p < 0.05). Out of a possible score of 7.0 points for the nature of the regenerated tissue, the scores for the three groups were: immobilization in a cast, 4.1 points; intermittent active motion, 4.0 points; and continuous passive motion, 5.9 points (P > 0.05). Out of a possible perfect combined score of 10.0 points for the structural characteristics of the regenerated tissue, the cast-immobilization group scored 3.8 points; the intermittent active-motion group, 2.5 points; and the continuous passive-motion group, 6.4 points (p < 0.001). The total scores for freedom from cellular changes of degeneration, a perfect score being 5.0 points, were: immobilization in a cast, 2.4 points; intermittent active motion, 2.3 points; and continuous passive motion, 3.9 points (p < 0.01). Degenerative changes in the adjacent cartilage, which were noted in 42 and 46 per cent of the knees in the immobilization and intermittent active-motion groups, respectively, were not found in the knees that had been subjected to continuous passive motion (p < 0.05). The total indices, which were derived by combining the scores for all categories (maximum, 24.0 points), revealed that the index for the continuous passive-motion group was significantly better than the index for either of the other two groups: immobilization in a cast, 12.9 points; intermittent active motion, 11.2 points; and continuous passive motion, 19.2 points (p < 0.0005). The mean percentage of type-II collagen in the regenerated tissue was not significantly different for the three groups: immobilization in a cast, 76 per cent; intermittent active motion, 87 per cent; and continuous passive motion, 84 per cent (p = 0.4). These results demonstrate that the hyaline cartilage that is produced by free periosteal grafts in full-thickness osteochondral defects is capable of withstanding a full year of articular function without marked deterioration, especially in rabbits that are treated by continuous passive motion postoperatively. Although these are not perfect results, to our knowledge they represent a substantial improvement compared with the results of any experiments on the regeneration or repair of cartilage that have been reported to date. CLINICAL RELEVANCE: If free periosteal grafts in the human also are capable of replacing an area of lost or damaged hyaline articular cartilage with a new tissue that possesses morphological and biochemical characteristics that are similar to those of the original articular cartilage, and if they are capable of maintaining those characteristics over a long period of time, then the concept of biological resurfacing of a diseased or injured joint should be practicable. An effective method of biological resurfacing of full-thickness defects would be desirable as a biological alternative to prosthetic replacement of damaged or diseased joints, especially in children, adolescents, and active young adults for whom prosthetic replacement of a joint is not an appropriate treatment.

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Accession: 005199110

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