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PubMed2001

The role of periosteum in cartilage repair.

Periosteum, which can be grown in cell and whole tissue cultures, may meet one or more of the three prerequisites for tissue engineered cartilage repair. Periosteum contains pluripotential mesenchymal stem cells with the potential to form either cartilage or bone. Because it can be transplanted as a whole tissue, it can serve as its own scaffold or a matrix onto which other cells and/or growth factors can be adhered. Finally, it produces bioactive factors that are known to be chondrogenic. The chondrocyte precursor cells reside in the cambium layer. These vary in total density and volume with age and in different donor sites. 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. Many growth factors that regulate chondrocytes and cartilage development are synthesized by periosteum in conditions conducive to chondrogenesis. These include transforming growth factor-beta 1, insulinlike growth factor-1, growth and differentiation factor-5, bone morphogenetic protein-2, integrins, and the receptors for these molecules. By additional study of the molecular events in periosteal chondrogenesis, it may be possible to optimize its capacity for articular cartilage repair.

Age Factors↗
PubMed1995

Bone induction of hydroxyapatite combined with bone morphogenetic protein and covered with periosteum.

Using a rabbit model, we evaluated the role of the periosteum in bone induction using hydroxyapatite ceramic pellets, some of which had been coated with bone morphogenetic protein. Eighteen rabbits were divided into two groups, a control group that received pellets soaked in phosphate-buffered saline alone and another group for which the pellets had been supplemented with bone morphogenetic protein. After making a skin incision on the head of each rabbit, two caudally pedicled periosteal flaps measuring 1 cm in width and 2.5 cm in length were elevated. These flaps were wrapped around hydroxyapatite pellets manufactured from limestone and fixed with sutures. After implantation, both groups of rabbits were returned to their cages, maintained for 3, 6, or 9 weeks [every group consisted of 3 rabbits (6 pellets)], and then sacrificed. In this study, the extent of bone induction, which was measured with a dual x-ray densitometer, that resulted from covering the hydroxyapatite pellet with periosteum alone (control group) was minimal. On the contrary, since osteogenesis from the periosteum toward the pores of the pellet was observed in the bone morphogenetic protein group much more than in the control group, the usefulness of our technique was confirmed. However, active osteogenesis was observed with subperiosteal implantation of the hydroxyapatite-bone morphogenetic protein complex in the bone morphogenetic protein group, but the osteogenesis observed was not distributed over the entire pellet.

Animals↗
PubMed1996

Histologic and biochemical analysis of osteogenic capacity of vascularized periosteum.

We analyzed the osteogenic capacity of the vascularized periosteum histologically and biochemically using a new experimental model of the vascularized tibial periosteum-hydroxyapatite composite in rats. Bone formation was observed not only on the surface but also in the pores of the hydroxyapatite at 4 weeks. The alkaline phosphatase activity increased to a peak at 2 weeks, with half this activity maintained until 8 weeks. The bone-specific bone gla protein content increased constantly as time passed. On the other hand, in the vascularized fascia-hydroxyapatite composite group (control group), no bone formation was observed histologically, alkaline phospatase activity was low, and bone gla protein content was very low. These results indicate that (1) the vascularized periosteum has the most significant osteogenic capaacity at 2 weeks, with a constant level of the activity maintained thereafter, (2) it forms new bone soon after operation, and (3) the amount of bone increases as time passes.

Alkaline Phosphatase↗
PubMed1986

Innervation of periosteum and bone by sympathetic vasoactive intestinal peptide-containing nerve fibers.

Neural control of bone metabolism and growth has been suggested, although the identity of participating neurons and neurotransmitters effecting this control has not been established. Immunohistochemical studies demonstrated a system of vasoactive intestinal peptide (VIP)-immunoreactive nerve fibers that innervate periosteum and bone in several mammalian species. Thoracic sympathetic chain ganglionectomy resulted in an ipsilateral loss of VIP-immunoreactive fibers in the periosteum of ribs, whereas dorsal root ganglionectomy had no effect. Injection of fast blue into rib periosteum labeled a population of VIP-immunoreactive sympathetic postganglionic neurons. Thus, postganglionic sympathetic neurons may provide an important means by which VIP regulates bone mineralization.

Animals↗
PubMed1983

Revascularized periosteum transplantations.

A controlled experiment was performed in 56 African pygmy goats, analyzing the bone-forming capacity of two different revascularized periosteum grafts in midshaft tibial defects. At radiological examination revascularized tibial periosteum grafts firmly bridged the defect within 8 weeks, revascularized costal periosteum grafts did not.

Animals↗
PubMedDate not supplied

Role of periosteum on the fate of pedicle osteocutaneous grafts.

Recent studies on the fate of pedicle osteocutaneous grafts have shown that they remain viable and may be actively involved in the mechanics of bone repair. This communication reports on a series of experiments aimed to clarify the role of periosteum in the survival of pedicle-assisted bone grafts. Osteocutaneous grafts were developed in dogs in such a manner as to isolate the implant from normal recipient bone. Free bone grafts were used as controls and a group of pedicle periosteal grafts were studied as potential sources of bone formation. Specimens were evaluated at regular intervals over a 40-week period. The pedicle bone grafts maintained their viability and developed vigorous osteoneogenesis. The process was progressive and eventually resulted in partial substitution of the original graft by new bone of periosteal origin. The free bone grafts were resorbed and no bone formation was obtained in pedicle periosteum specimens. The study provides clear evidence that under experimental conditions no bone contact is needed to maintain the viability of pedicle osteocutaneous grafts. It also shows that the periosteum has the leading role in the restructuring process of these grafts.

Animals↗
PubMed2007

Effective bone engineering with periosteum-derived cells.

Bone augmentation via tissue engineering has generated significant interest. We hypothesized that periosteum-derived cells could be used in place of bone marrow stromal cells (which are widely used) in bone engineering, but the differences in osteogenic potential between these 2 cell types are unclear. Here, we compared the osteogenic potential of these cells, and investigated the optimal osteoinductive conditions for periosteum-derived cells. Both cell types were induced, via bFGF and BMP-2, to differentiate into osteoblasts. Periosteal cells proliferated faster than marrow stromal cells, and osteogenic markers indicated that bone marrow stromal cells were more osteogenic than periosteal cells. However, pre-treatment with bFGF made periosteal cells more sensitive to BMP-2 and more osteogenic. Transplants of periosteal cells treated with BMP-2 after pre-treatment with bFGF formed more new bone than did marrow stromal cells. Analysis of these data suggests that combined treatment with bFGF and BMP-2 can make periosteum a highly useful source of bone regeneration.

Adolescent↗
PubMed1977

Evidence for preferential effects of parathyroid hormone, calcitonin and adenosine on bone and periosteum.

In order to explore the distribution of hormone-responsive cells in skeletal tissues, we have examined the effects of synthetic bovine parathyroid hormone N-terminal peptide (bPTH 1-34) and salmon calcitonin (sCT) on cyclic AMP levels in periosteum-free rat calvaria, segments of periosteum, and in isolated cells dispersed from each tissue by collagenase digestion. Synthetic bovine PTH increased cyclic AMP levels to a greater degree in calvaria and in isolated bone cells than in the periosteal segments and cells, whereas sCT was more effective in the periosteal than in the bone systems. Primary cultures prepared from bone and periosteal cell populations exhibited progressive increases in their responsiveness to bPTH (1-34) and progressive decreases in responsiveness to sCT. After six days in the culture, bone cells failed to respond to sCT, and sCT did not modify their response simultaneously added bPTH (1-34). Six-day periosteal cell cultures exhibited residual sCT responsivity and an additive response upon simultaneous exposure to high concentrations of bPTH (1-34) and sCT suggesting separate sites of hormone action. Adenosine, a known stimulator of bone cell adenylyl cyclase, caused a greater increase in periosteal cell than in bone cell cyclic AMP. bPTH (1-34)-responsive cells which enrich periosteum-free bone may be osteoblasts, in view of their histological prominence in this tissue and in the bone cell isolates. Periosteal cells which responded to sCT and to adenosine preferentially are unidentified. Although periosteal segments contained numerous fibroblast-like cells, skin fibroblasts cultured from the same fetuses were sCT-insensitive. Growth in primary culture appears to alter the number of hormone-responsive cells or responsiveness of existing cells to each hormone, or both.

Adenosine↗
PubMed1988

Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum.

The histology and mechanics of leg lengthening by callus distraction were studied in 27 growing rabbits. Tibial diaphyses were subjected to subperiosteal osteotomy, held in a neutral position for 10 days and then slowly distracted at 0.25 mm/12 hours, using a dynamic external fixator. Radiographs showed that the gap became filled with callus having three distinct zones. Elongation appeared to occur in a central radiolucent zone; this was bounded by two sclerotic zones. Histologically, the radiolucent zone consisted of longitudinally arranged cartilage and fibrous tissue while the sclerotic zones were formed by fine cancellous bone. New bone occasionally contained islands of cartilage, suggesting it had been formed by endochondral ossification. After completion of distraction, the two sclerotic zones fused, shrank and were eventually absorbed, leaving tubular bone with a new cortex. When the periosteum had been removed at the operation, callus formation was markedly disturbed and there was failure of bone lengthening. Scraping of endosteum, in contrast, did not have a pronounced effect. These results suggest that the preservation of periosteum is essential if bone lengthening by callus distraction is to succeed, and that preservation of the periosteum is more important than careful corticotomy.

Animals↗
PubMed1978

Quantitative assessment of free gingival grafts with and without periosteum and osseous perforation.

Forty free gingival grafts were performed on 5 adult Rhesus monkeys as follows: 10 grafts were placed on recipient sites with periosteum; 10 grafts on periosteum and perforated cortical plate; 10 grafts on bared bone; and 10 grafts on perforated bared bone. All free autografts (7 X 5 X 1 mm) were taken from the palatal mucosa and were sutured in place. Clinical evaluation and photographs were taken at 1, 2, 4, 8, 12, 16, 20 and 24 weeks postoperatively. At 24 weeks, a device was used to measure quantitatively the amount of force necessary to pull the graft 2 mm away from the underlying bone. Biopsy of two grafts of each type were taken for histologic examination. The following conclusions were drawn: 1. There was no difference in the survival or healing pattern of grafts placed on periosteum and grafts placed on bared bone.

Alveolar Process↗
PubMed1998

Different response to osteo-inductive agents in bone marrow- and periosteum-derived cell preparations.

Rabbit bone marrow- and periosteum-derived cells were cultured in medium containing dexamethasone, bone morphogenetic protein-2 (BMP2) or both. The response of bone marrow-derived cells, measured as alkaline phosphatase expression, depended on the stage of growth. In subconfluent cultures, BMP2 had a greater effect than dexamethasone and treatment with both further increased enzyme activity. In confluent cultures, the effect of dexamethasone was greater than that of BMP2 and, when used together, they had an additive effect. The mineral deposition observed in these cultures did not have the typical structure of bone nodules. For periosteum-derived cells, dexamethasone did not increase the expression of alkaline phosphatase, while BMP2 did; treatment with both was less effective than treatment with BMP2 alone. Typical bone nodules were observed in cultures of periosteum-derived cells treated with dexamethasone and BMP2. These findings indicate that either osteoprogenitor cells from these two sources are intrinsically different or else non-progenitor cells in the preparations directly or indirectly affect the responsiveness to osteo-inductive agents.

Alkaline Phosphatase↗
PubMedDate not supplied

Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy.

PURPOSE: To report a new surgical approach that uses ocular fixation to the nasal periosteum with superior oblique tendon for patients with complete third nerve palsy. METHODS: Prospective study of 15 patients with complete third nerve palsy who underwent surgery using a superior oblique tenectomy and ocular fixation to the nasal periosteum with the superior oblique tendon fragment. RESULTS: Eleven (73%) patients achieved good ocular alignment, 1 (7%) patient had a cosmetically acceptable result, and 3 (20%) patients had a cosmetically unacceptable result. Five (30%) patients had preoperative diplopia; all achieved resolution of their double vision in the primary position of gaze after surgery. Two patients without preoperative diplopia did not achieve good alignment and had diplopia postoperatively. Follow-up ranged from 8-41 months (mean: 19 months). No operative complications occurred. CONCLUSION: Ocular fixation to the nasal periosteum with superior oblique tendon is a safe, effective, and technically undemanding option for the surgical management of patients with complete third nerve palsy.

Adolescent↗
PubMed2000

[Experiment study of guiding bone tissue regeneration by frozen homologous periosteum].

OBJECTIVE: Explores the feasibility of guiding bone tissue regeneration by frozen homologous periosteum. METHODS: Rabbit's cranial periosteum was taken and refrigerated. In thirty-one white Japanese big ear rabbits, defects of the mandible were created. Defect at one side was covered with the membrane, another side not. The rabbits were sacrificed on four, eight, twelve, sixteen weeks. Specimens were examined by naked eye, X-ray, and histology. RESULTS: The frozen homologous periosteummet the requirement of guiding bone tissue regeneration There was no rejection, and could be kept 8 for 12 weeks in the body. It had the favorable efficacy of obstructing the fiber tissue from filling into bone defects and had an efficacy of guiding bone tissue regeneration. CONCLUSIONS: Frozen homologous periosteum is a perfect guiding bone tissue regeneration membrane.

Animals↗
PubMed2000

[Treatment of ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum].

OBJECTIVE: To investigate the therapeutical effect of treatment of ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum. METHODS: From June 1983 to August 1997, 106 cases with ischemic necrosis of femoral head (II stage in 64 cases, III stage in 39 cases, IV stage in 3 cases) were treated by the transfer of vascular pedicled iliac periosteum with ascending branch of lateral femoral circumflex vessel or deep circumflex iliac vessel pedicle. RESULTS: Followed up 2 years and 4 months to 16 years, there were excellent in 54 cases, better in 38 cases, moderate in 9 cases, poor in 5 cases, and 86.8% in excellent rate according to the criterion of the therapeutical effect on the repair and reconstruction of adult ischemic necrosis of femoral head. CONCLUSION: Treating ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum has the advantage of constant pedicle, easily drawing materials and reliable therapeutical effect.

Adolescent↗
PubMed2004

[Repair of femoral neck fracture with vascular pedicled periosteum flap transfer in young and middle-aged].

OBJECTIVE: To estimate clinical effect of spin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middle-aged. METHODS: From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap was stripped off, and transferred to the front of femoral neck fundus, then transplanted to the narrow inside of fracture through outer open door of articular capsule. RESULTS: All patients were followed up for 1-7 years. All fracture healed without femoral head necrosis, but mild arthritis appeared in 7 cases. CONCLUSION: Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.

Adult↗
PubMed2005

[Periosteum construction in vitro by small intestinal submucosa combined with bone marrow mesenchymal stem cell].

OBJECTIVE: To investigate the practicability of periosteum construction in vitro by small intestinal submucosa (SIS) as a tissue scaffold with bone marrow mesenchymal stem cells (BMSC). METHODS: The bone marrow mesenchymal stem cells were cultivated by the conventional method in vitro, and then co-cultivated with SIS. The morphological feature of the complex material, the extracellular matrices, the adhesion and proliferation of BMSC were observed by optical microscope, electronic microscope, scanning electronic microscope and histologic evaluation respectively. RESULTS: BMSCs adhered and proliferated on SIS, secreted a great deal of extracellular matrices with active cellular function. BMSCs grew well there in layers, and the thickness became thicker as time passed, acting like a biological periosteum. CONCLUSION: Combined culture of SIS and BMSC in vitro can construct a tissue engineering periosteum similar to the natural one, thus providing a base for further study of its osteogenic regeneration in vivo.

Animals↗
PubMed2006

Free iliac crest grafts with periosteum for treatment of old acetabular defects.

OBJECTIVE: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. METHODS: From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reduced. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securely fixed by two to three leg screws. RESULTS: Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32.3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases. CONCLUSIONS: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.

Acetabulum↗
PubMedDate not supplied

Comparison of oblique closing base wedge osteotomies of the first metatarsal: stripping versus nonstripping of the periosteum.

The authors present a study comparing two methods of performing the oblique closing base wedge osteotomy of the first metatarsal for correction of hallux abducto valgus deformity. In one group, the periosteum was stripped from the metatarsal prior to performing the osteotomy, and in the other group, the osteotomy was performed through the periosteum. Sixty-five osteotomies are included in the study. This article discusses the closing base wedge osteotomy, fracture healing and the role of the periosteum, the blood supply to the first metatarsal, and the effects of periosteal stripping. Also included is a presentation of the surgical technique used, a statistical review of the procedures performed, a critical discussion summarizing the results, and a discussion of the postoperative complications encountered.

Female↗