Articular Cartilage Regeneration Using Periosteum

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Abstract
Periosteum has chondrogenic potential that makes it possible to repair or regenerate cartilage in damaged joints. Whole periosteal explants also can be cultured in vitro for the purpose of studying chondrogenesis. This chondrogenic potential arises because the cambium layer of periosteum contains chondrocyte precursor cells that form cartilage during limb development and growth in utero, and does so once again during fracture healing. The advantages of whole tissue periosteal transplants for cartilage repair include the fact that this tissue meets the three primary requirements for tissue engineering: a source of cells, a scaffold for delivering and retaining them, and a source of local growth factors. Data from in vivo studies show that periosteum transplanted into osteochondral articular defects produce cartilage that can restore the articular cartilage and be replaced by bone in the subchondral region. This capacity is determined by surgical factors such as the orientation of the cambium layer, postoperative factors such as the use of continuous passive motion, and the age and maturity of the experimental animal. In vitro studies have shown that the chondrogenic potential of periosteal explants is determined by culture, donor conditions, and technical factors. Chondrogenesis is optimized by suspension of the explants in agarose under aerobic conditions, with supplementation of the media using fetal calf serum and growth factors, particularly transforming growth factor-beta 1. The role of physical factors currently is being investigated, but studies show that the mechanical environment is important. Donor factors that are important include the harvest site, the size of the periosteal explant, and most importantly the age of the donor. Periosteal chondrogenesis follows a specific time course of events, with proliferation preceding differentiation. The current challenge is to clarify the process of periosteal chondrogenesis and its regulation at the cellular and molecular levels, so that it can be controlled intelligently and optimized for the purpose of cartilage repair and regeneration.