An experimental study, repairing of articular cartilage by free periosteal graft in rabbit, was designed. Two 4.5mm wide circular full-thikness cartilage defects were drilled on the medial femoral condyle, in 24 adult rabbits. A graft of periosteum from the proximal tibia was fitted into the defect (right side), by using fibrinogen glue. On the control side (left side), the defect was fulled with fibrinogen glue, or repaired by periehondrial grafts which were taken from their own ribs. This experiment indicated that both periosteum and perichnodrium have the same potential of cartilagious regeneration. And the processes of regeneration are also the same. So we suggest to use free autologous periosteal grafts to replace free autologous perichondrial grafts to cure the articular cartilage defects.
Abstract In order to find a new method to repair large bone defect, the free periosteum autograft was investigated in experiment, and then the method was used clinically. In the experiment, a 6mm×18mm×5mm bone defect was made at upper end of both tibiae of 42 rabbites. The periosteum of each rabbit was cut into 1mm cubes, and implanted randomly into the tbial bone defect on one side and the other side was used as control. After 2, 4, 8 weeks, the bone defects of each group were examined for bone formation by roentgenography, radionuclide and histology. The results showed that the defects treated by free periosteum autografts healed twice as fast as the controls (its natural healing). The reason probably was that the periosteum provided with many osteogenic cells. On thebasis of these results, 21 cases of bone defects (the largest was 10.5cm×4cm×4cm, the smallest was 2cm×2cm×2cm) including 17 cases of benign bone tumor and4 cases of chronic osteomyelitis, were treated by free periosteum autografts. The defects were all healed, and the function of the joints was restored.
Objective To observe the long-term clinical results of repairing large articular cartilage defects of the hip and the knee with free autogeneous periosteum. Methods Based on the results of experimental studies, the authors used free autogeneous periosteum transplantation and postoperative continuous passive motion (CPM) to repair large articular cartilaginous defects in 52 patientsfrom February 1987 to August 1995. Of 37 patients with complete follow-up data, 16 had congenital dislocation of the hip, 6traumatic arthritis of hip, 1 femoral head destruction following mild infection, 2 ankylosing spondylitis, 6 intra-articular fracture of the knee, 4 arthritisof the knee and 2 stiff knee following joint infection. The patients with dislocation of hip were given relieving traction before operation. The cartilages of pathological changes were excised to bleeding bone. The defects were repairedwith periosteum removing from tibia. CPM were immediately applied for 4-6 weeksand no bearing was allowed 6 months after discharge. The silicon membrane was taken out in the 6th month. Results Thirty-seven patients (17 males, 20 females) were followed up 7-15 years with an average of 10.5 years. The functional evaluation referred to joint pain degree，joint mobile range，daily activity and X-ray findings. The results were excellence in 11 patients , good in 18 patients , poor in 8 patients. Conclusion The method to repair articular cartilage defect with free autogeneous -periosteum is effective and may be applied clinically.
This article introduced a newmethod of repaire of osteocutaneousdefect of the lower leg by thetransfer of periosteocutaneous flap.The donor artery was the posteriortibial artery which supplied the skinof the medial aspect of the middleand lower leg. The medial skin flapof the leg had vascular communicat-ion with the periostium of the ant-erior aspect of the tibia. The shapeand size of the flap could be design-ed according to the recipient area,and the flap axis should be along theline from medial tibial condyle to the medial malleolus, generelly at the level of 3.7.11. or 15cm above the medial malleolus. The skin defect could be repaired by free graft, and 2 patients received this operation had achieved good result after 1 year follow-up.
Abstract To investigate the ectopic new bone formation following implantation of bovine hydroxyapatite Bio-oss together with free periosteum, 12 chabb: ch rabbits were selected. In 10 rabbits, Bio-oss block together with free periosteum was implanted in the gastrocnemius muscle of one leg randomly, and Bio-oss block alone was implanted in the same muscle of the other leg. In the other 2 rabbits, the periosteum was implanted into the gastrocnemius musle of both legs. Histologic examination and quantitative analysis of newbone formation were performed at 3 and 6 weeks postoperatively. The results showed that in the legs implanted bovine hydroxyapatite Bio-oss together with freeperiosteum, new bone formation began at 5th day after implantation. The area ofnew bone composed of 19.0% of the specimens at 3 weeks postoperatively. No boneformation through out the experimental period in Bio-oss block alone implantedlegs and also periosteum implanted legs. We concluded that bovine hydroxyapatite Bio-oss has a good capacity of osteoconduction. New bone can be formed after the implantation of hydroxyapatite combined with free periosteum.
Objective To study and compare boneforming mechanismafter compound of autologous periosteum-wrapped tendon with spongiosa homogenate and other implants in articular cavity, and to explore the possibility of the compound as a substitute for the lunate in Kienbock’s disease.Methods Forty-five New Zealand white rabbits were randomly divided into three groups: periosteum group(group A, n=15), composite group(group B, n=15), and control group(group C, n=15). The three sorts of implants were placed into articular cavity of the knee respectively. The changes of bone formation and bone morphogenetic protein (BMP) distribution of the implants were examined under optical microscope with HE and immunohistochemical staining and measured by CT 3, 6 and 9 weeks after operation.Results The result of BMP staining was negative after 3 weeks and positive in new cartilage cells after 9 weeks in group A. The positive BMP staining was observed in group B after 3 weeks and 9 weeks, which mainly distributed in new bone cells and cartilage cells. And negative BMP staining was observed every stage in groupC. The quantitative CT bone mineral density (BMD) values of 3 implants were analyzed, the difference was significant between the groups (Plt;0.01), except that between groups A and C in the 3rd week (Pgt;0.05). Conclusion The above results demonstrated that the compound of autologous periosteum-wrapped tendon and spongiosa homogenate can produce bone and cartilage massively under the induction of periosteum and bone-forming factors such as BMP in spongiosa homogenate and the compound can be used as a substitute for the lunate.
In order to observe the histological changes of the autogenous perichondrium graft from rib in the repair of injured articular cartilage of the condylar process of mandible, 50 rabbits were used, in which 15 were served as control. The articular cartilage with its subchondral bone were resected and an autogenous graft of costal perichondrium was sutured onto the raw surface of the condylar process, and in the controls, only the articular portion of the condylar process was resected without the application of autogenous costal perichondrium graft. The morphological changes of the newly formed cartilage during the process of its development were investigated by hiostological and autoradiog aphic techniques. The result revealed that 10 days after operation, the graft had increased in thickness and was richly populated form the proliferation of mesenchyme-like cells. Twenty to thirty days later, the chondrocytes were matured and the newly formed cartilage had covered the bony surface of mandibular condyle. At 60 days, the newly formed cartilagenous joint surface became glossy, and the morphology and arrangement of cells tended to be regular simulating the morphology of normal articular cartilage. From the experiment, it could be concluded that (1) The autogenous perichondrium graft placed on the condylar surface of mandible could form new articular cartilage which was similar in tissue morphology to the normal condylar cartilage. (2) The process of development of newly formed cartilage was similar to that of the normal cartilage. (3) The motion and loading on the joint could promote the formation of new cartilage and undergo biological reformation, gradually resulting in normal joint morphology. On this basis, the clinical application of autogenous perichondrium graft to repair injured cartilage of the condylar process of the mandible was feasible.
Based on the anatomical studies, the authors had designed an operation for treating old dorsal subluxation of the inferior radio-ulnar joint.The periosteum was longitudinally incised at the dorsal side of the lower ulna. forming musculo-periosteal flap, and a periosteal flap, and a periosteal valves of pronator quadratus. They were subluxation, passing the flap from palmar to the dorsal side through thc subperiosteal tunnel at the lateral margin of the radius corresponding to the ulna. Then it was circled round the lower end on the ulna and sutured to the muscular flap and the tough interosseous membranes at the palmar side, being used to stabilize the recuperated dorsal subluxation of the inferior radio-ulnar joint. The result of its clinical use was satifying.