Rib cartilage grafting in upper limb surgery: an overview

Abstract

Introduction: Used routinely in maxillofacial reconstructive surgery, the chondrocostal graft is also used in hand surgery. The purpose of this overview was to analyze at long follow-up the radiological and histological evolution of this autograft, in the hand and wrist surgery. Materials and methods: Since 1992, 144 patients have benefitted from a chondrocostal autograft: 116 osteoarthritis of the thumb carpometacarpal joint, 18 radioscaphoid arthritis, six articular malunions of the distal radius, four kienbock, and four traumatic loss of cartilage of the PIP joint. Magnetic Resonance Imaging (MRI) was performed in 19 patients and histological study in 12 patients with a mean follow-up of 68 months (4–159). Results: Whatever the indication, the reconstruction by a chondrocostal or ostochondrocostal graft has allowed us to obtain satisfactory clinical results at long follow-up. The main question was the viability of the graft. The radiological study has shown the non-wear of the graft and a certain degree of ossification. The MRI confirmed a very small degree of osseous metaplasia but its viability. The biopsies showed a neo-vascularization of the cartilage. Conclusion: Despite the strong mechanical strain in the hand and wrist, the chondrocostal graft is a biological arthroplasty, trustworthy and secure at long time even if it can cause infrequent complications inherent to this type of surgery. Despite the inevitable histological modification, the cartilage remains alive and is of satisfactory quality at long term follow-up and fulfilling the requirements for interposition and reconstruction of an articular surface.

Costo-osteochondral graft (rib graft) reconstruction of the irreparable proximal scaphoid

“…Progressive ossification of the graft was noted in 14 of 21 patients on plain follow-up radiographs. A possibly progressive ossification of the graft has been previously described (Loisel et al., 2018; Obert et al., 2015; Tropet et al., 2012). Ossification varied in appearance from patient to patient in our series.…”

“…Costo-osteochondral grafts have been used routinely for many years in maxillofacial reconstructive surgery and have also been used in reconstructive procedures in upper limb and hand surgery (Huard et al, 2011; Loisel et al., 2018; Obert et al., 2015). Sandow (1998) described reconstruction of the scaphoid with an osteochondral rib graft.…”

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“…There were no signs of infection and an excellent union found between the graft and ramus of the mandible. This bone remodeling or osteogenesis process might be because of osseous metaplasia 31 or previously calcified graft was used. Calcification of rib is a natural progression that should be carefully evaluated preoperatively using ultrasonography or dual-energy CT imaging 32 .…”

“…Due to the lack of availability of these investigations this study depended on the visual difference in the color of the costochondral junction. 31 The graft's growth seen more in the growing rabbits than the adults, indicating there might be a strong influence on the growth process of growing rabbits due to hormonal and growth factors. 10,29,32 In case of a few growing rabbits the graft grew mostly in width than in length and there were no sign of graft resorption.…”

Autologous Costal Cartilage Graft—A New Method to Treat Articular Cartilage Defects: Case Report and Note of Surgical Technique

“…The main elements contributing to the rationale for this choice were: (1) the graft is autologous and of hyaline nature; (2) the perichondrium of the graft has chondrogenic potential 17 ; (3) the costal graft is widely used in reconstructive surgery 18 19 and usually it has a low donor site morbidity 20 ; (4) the graft may be properly sized to cover large and full-thickness articular defects; (5) the method is “one-step ” and has a low cost.…”