Combination of microfracture and periosteal transplantation techniques for the treatment of full-thickness cartilage defects

Abstract

Microfracture and periosteal transplantation techniques were combined in order to enhance the quality of repair for the treatment of full-thickness cartilage defects. In 40 mature New Zealand white rabbits, a full-thickness cartilage defect of 4 mm was induced on the weight-bearing surfaces of the medial condyles of the right femur. The rabbits were randomly divided into four groups equal in size. Control animals remained untreated following defect induction. Two groups were either treated with periosteal transplantation or the microfracture technique, while the fourth group underwent combination of the two techniques. All the animals were immobilized for two weeks postoperatively. At the end of 12 weeks, the animals were sacrificed and the specimens were removed for evaluation according to the criteria of the ICRS scale (International Cartilage Repair Society), and with respect to newly regenerated cartilage areas and the number of viable chondrocytes. Specimens treated with the combination of the two techniques exhibited significant differences from the other groups in all criteria of the ICRS scale (surface, matrix, cellular distribution, cell viability, and cartilage mineralization) except for subchondral bone criteria. In addition, the mean number of viable chondrocytes and newly regenerated cartilage areas were the highest in this group (p=0.0001). Due to markedly improved quality of repair, the combination of the microfracture and periosteal flap techniques seems to be more effective than either of the techniques used alone in the treatment of cartilage defects.