Effects of periosteum wrapped around tendon in a bone tunnel: A biomechanical and histological study in rabbits

The present study demonstrated the effects of periosteal autograft on tendon-to-bone healing in the rabbits. In 20 Japanese white rabbits, proximal end of the long digital extensor tendon that was wrapped around by a periosteum was transplanted into a drill hole in the proximal tibial metaphysis. A fresh periosteum was used in the left tibia and a frozen periosteum was used in the right tibia. Six specimens were harvested at each 2, 4, and 6 weeks postoperatively. Radiological features showed progressive remodeling of trabecular bone surrounding the implanted tendon. This remodeling in fresh periosteal graft was earlier than that in frozen graft. Generally, the pull-out strength of the transplanted tendons with a fresh or frozen periosteum increased progressively according to the length of the healing periods. The strength was significantly greater in a fresh periosteal graft than that in a frozen graft at 4 weeks postoperatively. In histological analysis, a 4-week specimen with the fresh periosteal graft showed fibrocartilage formation in the bone tendon interface, whereas the specimens with the frozen graft demonstrated simple approximation of oriented fibrous tissue. In conclusion, the fresh periosteal autograft produced the premature form of fibrocartilagenous attachment in a bone tunnel and provided good mechanical strength.