Autologous periosteum transplantation for the treatment of full thickness patellar cartilage defects.

Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known that the cells in the cambium layer of the periosteum are pluripotent and can differentiate into hyaline (or hyaline-like) cartilage, especially if in a joint environment and under the influence of continous passive motion. In a few clinical studies autologous periosteum transplants alone have been used in the treatment of full thickness patellar cartilage defects. The results are varying. At our clinic, autologous periosteum transplantation alone, followed by continous passive motion (CPM) in the immediate postoperative period and non-weight bearing loading for 3 months, has shown promising clinical results. The best clinical results have been achieved on traumatic (fracture, contusion, dislocation) cartilage defects, where 83% of patients have been clinically graded as excellent or good at follow-up (> 2 years postoperatively). For non-traumatic patellar cartilage defects (chondromalacia NUD) the results are poor, with only 35% of patients being graded as excellent or good. Therefore, we believe that no-traumatic patellar cartilage defects (chondromalacia NUD) are less suitable for treatment with autologous periosteum transplants, and are at our clinic not any longer included for this type of treatment.