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The Journal of Bone and Joint Surgery, Vol 70, Issue 4 595-606, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
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. A follow-up report at one year
SW O'Driscoll, FW Keeley and RB Salter
Division of Orthopaedic Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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 less than 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 greater than 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 less than 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 less than 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 less than 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
less than 0.0005).(ABSTRACT TRUNCATED AT 400 WORDS)
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