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The Journal of Bone and Joint Surgery, Vol 68, Issue 7 1017-1035, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
The chondrogenic potential of free autogenous periosteal grafts for biological resurfacing of major full-thickness defects in joint surfaces under the influence of continuous passive motion. An experimental investigation in the rabbit
SW O'Driscoll, FW Keeley and RB Salter
A rectangular graft of autogenous tibial periosteum was sutured (with its
cambium layer facing into the joint) onto the base of a five by
ten-millimeter full-thickness defect in the patellar groove of each of 143
adolescent and adult rabbits. The rabbits were managed postoperatively by
either immobilization, intermittent active motion, continuous passive
motion for two weeks, or continuous passive motion for four weeks. When the
animals were killed four weeks postoperatively, the contour of the patellar
groove had been restored in all of the rabbits in the group that had had
four weeks of continuous passive motion, and the newly formed tissue in all
of the defects in this group had the gross, histological, and histochemical
appearance of smooth, intact hyaline articular cartilage. Histologically,
the nature of the tissue that had formed, as well as its surface
regularity, structural integrity, and bonding to the adjacent cartilage,
were significantly better in the group that had had four weeks of
continuous passive motion than in any of the other groups. The results were
significantly worse when the orientation of the periosteal graft was
reversed (that is, when it had been sutured into the defect with the
cambium layer of the graft facing the subchondral bone rather than into the
joint) or when no periosteal graft was used. Biochemical analyses revealed
that, in the group that had had four weeks of continuous passive motion,
the total hexosamine content, the levels of chondroitin sulphate and
keratan sulphate, and the ratio of galactosamine to glucosamine were all
comparable with the values for normal articular cartilage. In contrast, in
the groups that were treated by immobilization, intermittent active motion,
or two weeks of continuous passive motion, as well as in the adult rabbits,
the content of the first three of these substances was significantly less
than normal. In the groups that were treated by immobilization,
intermittent active motion, or two weeks of continuous passive motion, 32
to 47 per cent of the total collagen was type II, while in the group that
had had four weeks of continuous passive motion, 93 per cent of the total
collagen was type II. These results demonstrate that, under the influence
of continuous passive motion, free autogenous periosteal grafts can repair
a large full-thickness defect in a joint surface by producing tissue that
resembles articular cartilage grossly, histologically, and biochemically,
and that contains predominantly type-II collagen.
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