Abstract
The regeneration capacity of knee cartilage can be enhanced by applying periosteal grafts, but this effect varies depending on the different sources of the periosteal grafts applied for cartilage formation. Tibia periosteum can be used to enhance cartilage repair. However, long-term analysis has not been conducted. The endochondral ossification capacity of tibia periosteum during cartilage repair also needs to be investigated. In this study, both vascularized and non-vascularized tibia periosteum grafts were studied to understand the relationship between tissue perfusion of the periosteum graft and the effects on cartilage regeneration and bone formation. Furthermore, anti-ossification reagents were added to evaluate the efficacy of the prevention of bone formation along with cartilage regeneration. A critical-size cartilage defect (4 × 4 mm) was created and was covered with an autologous tibia vascularized periosteal flap or with a non-vascularized tibia periosteum patch on the knee in the rabbit model. A portion of the vascularized periosteum group was also treated with the anti-osteogenic reagents Fulvestrant and IL1β to inhibit unwanted bone formation. Our results indicated that the vascularized periosteum significantly enhanced cartilage regeneration in the cartilage defect region in long-term treatment compared to the non-vascularized group. Furthermore, the addition of anti-osteogenic reagents to the vascularized periosteum group suppressed bone formation but also reduced the cartilage regeneration rate. Our study using vascularized autologous tissue to repair cartilage defects of the knee may lead to the modification of current treatment in regard to osteoarthritis knee repair.
Highlights
The regeneration capacity of knee cartilage can be enhanced by applying periosteal grafts, but this effect varies depending on the different sources of the periosteal grafts applied for cartilage formation
This result is contrary to our previous study, in which an axial-patterned vascularized tibia periosteal flap was applied to repair cartilage defects of the knee in a rabbit model and showed promising cartilage repair 4 weeks after surgery in comparison to the non-periosteum group[13]
Our aims were to investigate the role of the inclusion of vascularity in the periosteum to enhance chondrogenesis and to determine whether or not supplementation with two bone inhibitors, Ful and IL1β, helps in reducing osteogenesis during the process of cartilage repair
Summary
The regeneration capacity of knee cartilage can be enhanced by applying periosteal grafts, but this effect varies depending on the different sources of the periosteal grafts applied for cartilage formation. Our results indicated that the vascularized periosteum significantly enhanced cartilage regeneration in the cartilage defect region in long-term treatment compared to the non-vascularized group. The result indicated that endochondral ossification appears to be favored when the periosteum graft is implemented as a non-vascularized graft[12] This result is contrary to our previous study, in which an axial-patterned vascularized tibia periosteal flap was applied to repair cartilage defects of the knee in a rabbit model and showed promising cartilage repair 4 weeks after surgery in comparison to the non-periosteum group[13]. Considering the controversial effects of vascularity in the periosteum, the first goal of our study was to compare the cartilage regeneration capacity using the vascularized pedicled periosteal flap and a non-vascularized periosteal graft in long-term treatment. Blocks, and accelerates degradation of the ER protein and leads to complete inhibition of estrogen signaling through the ER15–17
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