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Osteochondral Autograft Transplantation for Articular Defects in the Hand and Wrist
Paul A. Sibley, DO1; Sidney M. Jacoby, MD2; Abdo Bachoura, MD2; Randall W. Culp, MD2; (1)Philadelphia College of Osteopathic Medicine, (2)Thomas Jefferson University
Thomas Jefferson University - The Philadelphia Hand Center, Philadelphia, PA, USA

Hypothesis: The osteochondral autograft transfer system procedure (OATS) has been described for osteochondral defects. We hypothesize that this procedure can be used for articular defects in the hand and wrist, with good functional results.

Methods: After Institutional Review Board approval, we performed a retrospective chart review of four male patients from May 2010 until February 2011 who had an OATS procedure for an articular defect of their hand or wrist. The average age was 30 years old and all had failed months of conservative management. The patients’ injuries consisted of osteochondral defects in two proximal lunates, a proximal scaphoid, and an index metacarpal head. Outcome variables consisted of four month postoperative grip strength, range of motion, time to return to normal activity, and radiographic evidence of osteochondral plug in-growth.

Results: The average time from injury to surgery was 29 months, with an average follow-up of 5 months. Using our technique, we had no significant complications. The average gain of wrist motion was 6°, with grip strength gaining an average of 18 PSI. Radiographic evidence of graft position and an improved articular surface was seen in all the cases by final follow-up. All patients returned to their daily activities, including minor league baseball, golfing, and ice hockey.

Summary: We recommend considering this procedure in young, active patients with osteochondral defects of the hand and wrist. The OATS is a technically demanding procedure, but is a good first-line treatment option of focal osteochondral defects in higher demand individuals.1 It incorporates hyaline cartilage into the defect, with capabilities for regrowth and regeneration. As opposed to the fibrocartilage regrowth seen in microfracture surgery, hyaline cartilage is biomechanically superior as a tissue for the articular surface.2As such, a successful outcome after maintaining a congruent articular surface may be achieved if the graft incorporates and a motivated patient is able to complete an appropriate course of occupational hand therapy.

References:

1Lee YK, Lee M, Lee JM. Osteochondral autograft transplantation for osteochondritis dissecans of the scaphoid:case report. J Hand Surg. 2011;36A:820-823.

2 Miniaci A, Martineau PA. Technical aspects of osteochondral autograft transplantation. Inst Course Lect. 2008;57:447-455.


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