Technical considerations in periosteal grafting for osteochondral injuries

Periosteum has been used clinically for biologic resurfacing arthroplasty in small series of patients for almost two decades. The author's own experience with this technique in multiple joints, including the knee, has been similar to that already reported in the literature. Observations and considerations are discussed that might help avoid failure in future applications of this technique. Indications and surgical technique, including graft procurement and fixation, and postoperative treatment and possible complications are also described. The rationale for using periosteum as a chondrogenic tissue and the factors affecting its cartilage production are also outlined.