Rib Cartilage Graft for Posttraumatic or Degenerative Arthritis at Wrist Level: 10-Year Results

Abstract

Background?Posttraumatic arthritides of the radiocarpal joint, secondary to scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), or Kienb?ck disease or in cases of intraarticularmalunion of the distal radius, are classically solved by some type of arthrodesis procedure. Osteochondral grafting provides a possible motion-sparing option that can diminish pain in the active patient. Description of Technique?A chondrocostal graft harvested from the ninth rib was inserted and fixed with a plate in place of the articular defect in cases of a malunited intra-articular distal radius fracture (7 cases) or to replace the proximal pole of the scaphoid in cases of SNAC or SLAC (18 cases). In Kienb?ck disease, the graft was inserted as a free cartilage spacer (4 cases). Results?Harvesting the graft from the ninth rib had minimal morbidity without pleural injury in the reported series. Graft union was achieved in all cases of fixation. No graft resorption or necrosis were observed on X-ray and magnetic resonance imaging (MRI) evaluation at the longest follow-up of 10 years. Histological analysis performed at the time of plate removal showed the vitality of the graft. Two thirds of the patients had excellent or good results using the Green and O'Brien score. Conclusions?Reconstruction of a partially destroyed articular surface using a costal graft is reliable and provides an alternative option for resurfacing the articular surface with viable cartilage.

Clinical Results of Nonvascularized Metatarsal Articular Bone Grafting for Osteochondral Defects of the Radiocarpal and Distal Radioulnar Joint

“…Hand therapy started after 7 days with early active mobilization of the wrist and tendon gliding exercises assisted with a removable splint for 5 weeks. This is in contrast with the 3, 4, and 5 weeks of immobilization by Mehin et al, 4 Obert et al, 6 and Del Piñal et al, 5 respectively.…”

Potential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review

“… 25 A motion-sparing lunate reconstruction technique with costochondral autograft insertion as a free cartilage spacer also led to 4 pain-free patients at an average 2-year follow-up. 28 In 2 separate studies, following interposition arthroplasty using palmaris longus, 1 patient went from severe to mild pain postoperatively at the 7-year follow-up, 26 while another patient improved their VAS score from 6 to 2 at less than 1-year follow-up. 27 One patient who underwent interposition arthroplasty with a tensor fascia lata flap had occasional pain with exertion 11 years after surgery.…”

“…There was no significant difference in the mean grip strength among the 3 groups. Weighted interstudy average grip strength as a percentage of the contralateral side in the conservative, non-salvage group, and salvage group was 83% (4 studies, n = 24), 15 , 17 - 19 86% (5 studies, n = 24), 15 , 20 , 21 , 25 , 28 and 79% (7 studies, n = 40), 5 , 13 , 14 , 24 , 30 - 32 respectively, ( P = .28) (see Table 4 ). Within the non-salvage group, there was also no significant difference in weighted interstudy averages for radial osteotomies (86%, 3 studies, n = 16) 15 , 20 , 21 and lunate reconstruction (86%, 2 studies, n = 8) 25 , 28 ( P = .90).…”

Rib cartilage grafting in upper limb surgery: an overview

“…It is critical that less than the proximal two-thirds of the scaphoid be resected and the osteochondral cartilage graft (bone part toward the scaphoid and cartilaginous part toward the radius) be attached with at least two pins. We had not used screw fixation with this graft until very recently [ 22 ]. Now that 2-mm screws are available, we have modified our technique.…”