The importance of procedure specific training in harvesting periosteum for chondrogenesis

This study was performed to determine the influence of procedure specific and nonspecific training on the chondrogenic potential of explanted periosteum. Seven operators, with varying degrees of orthopaedic surgical experience and procedure specific training in periosteal harvesting, harvested 10 to 16 periosteal explants each from the proximal medial tibiae of 42 New Zealand White rabbits that were 2 months of age. The chondrogenic index assay involved culturing the explants in agarose suspension for 6 weeks, followed by computerized histomorphometric analysis. Chondrogenic indices (the average percent area of cartilage grown in the cultured explants) ranged from 12% to 81% and were influenced strongly by each operator's experience with the technique of periosteal harvesting. Average cartilage yields before practice were in the range of 12% +/- 4% for a technician and 44% +/- 6% for a surgeon, compared with 54% +/- 7% and 79% +/- 2%, respectively, after practice involving more than 300 explants each. Procedure specific experience (with the technique of periosteal harvesting) was more important than the academic qualifications or years of surgical experience in general. These data must be considered when planning or interpreting the results of studies involving periosteal explantation or grafting, or when periosteum serves as a source of mesenchymal stem cells.