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Long Term Follow-up of Four Cases of Osteochondral Autologous Transplantation for Metacarpal Head Chondral Defects
Louis Constantinou, BA; Orthopaedic Specialists, Inc; Tyson Cobb, MD; Orthopaedic Specialists, PC; Anna Walden, DC
Palmer Center for Chiropractic Research, Davenport IA

Introduction: The purpose of this study was to report long-term follow-up on four patients undergoing osteochondral autologous transplantation (OAT) for isolated cartilage defects of the metacarpal head.
Methods: IRB approval was obtained. There were 3 males and 1 female with a mean age of 37 years (range 31-47) who underwent OAT. Cartilage defects ranged in size from 5 to 10mm involving the thumb metacarpal head in 2 cases and the metacarpal head of the index finger in 2 cases. A single graft was used to restore the cartilage defect in all cases and all grafts were harvested from the knee ranging in size from 6 to 8mm. One patient died from unrelated causes. We obtained 4-year follow-up from chart review on the deceased patient. The other 3 returned for clinical evaluation with minimum of 10-year follow-up. Measurements obtained by an occupational hand therapist included NRS pain score (0=no pain and 10=worst pain imaginable), standard goniometer ranges of motion (degrees), and hand dynamometer grip strength (Kg). Disabilities of Arm, Shoulder, and Hand (DASH) scores were obtained at final follow-up in the 3 surviving patients.
Results: Preoperative, 1-year and long-term follow-up findings for pain, grip and flexion are shown in Table 1. All patients had full extension at the aforementioned time periods with the exception of one patient who had a 10-degree extension lag at one year that resolved at the 10-year visit. Ten-year follow-up DASH scores on the three surviving patients were 20, 15, and 0. Radiographs at 10 years showed some postoperative changes with mild degenerative changes without progression when compared to earlier postoperative radiographs (Figures 1 & 2). There were no known complications and no known long-term donor site morbidity.
Conclusion: Long-term results in these four cases suggest that OAT may be a viable surgical option for treatment of cartilage defects of the metacarpal head.
Figure 1. 10-year post-op



Figure 2. 10-year post-op



Table 1.



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