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Long Term Successful Wrist and Finger Joint Arthroplasty Using Cadaveric Meniscus for Osteochondral Defects in the Radiocarpal, Metacarpal, and Proximal Interphalangeal Joints
Don Hoang, MD, MHS; Daniel J. Gould, MD, PhD; Matthew Orgel, BS; David A. Kulber, MD
Keck School of Medicine, University of Southern California, Los Angeles, CA

Hypothesis: Osteochondral defects of the radiocarpal, metacarpophalangeal, and proximal-interphalangeal joints often necessitate joint arthrodesis or mechanical arthroplasty, which has a limited lifespan. In severely arthritic wrist and finger joints, we propose a novel adjunct for joint salvage using cadaveric meniscus for joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore normal intra-articular contact stress.
Methods: A total of 14 patients with osteochondral defects in five radiocapitate, five metacarpophalangeal, three proximal-interphalangeal and one carpometacarpal joint received cadaveric meniscus to facilitate arthroplasty. Patient demographic, peri-operative pain, range of motion, complications were examined.
Results: Patients aged 17 to 73 years old (average 54.6 years old) underwent joint reconstruction for scaphoid non-union (n=1), scaphoid-lunate advanced collapse (n=4), or osteoarthritis of MCP/CMC (n=6) or PIP (n=3) joints. Successful arthroplasty with joint space preservation occurred in all joints. Patients underwent postoperative hand therapy at 3 weeks and had a significant reduction in average pain scale score from 9.7 to 1.7 [p<0.01] and improved average range of active motion degrees of flexion 15 (wrist), 46 (MCP), PIP (50) [p<0.01]; degrees of extension 30 (wrist) [p < 0.05]. No complications resulted; only a revision tenolysis and capsulotomy were required for PIP and MCP arthroplasties. Post-operative films reveal preservation of arthroplasty joint space after an average 19.7 months follow-up (range 8 54).
Conclusion: We believe that meniscus is a viable joint salvage adjunct to preserve pain-free motion and avoid total joint arthrodesis. We have provided a case series of 14 patients who have benefited from the use of cadaver meniscus in hand joint arthroplasty cadaveric meniscus advantageously maintains a low metabolic demand, biointegrates, and is surgically malleable.

Figure 1. A. Osteochondral defect of radiolunate fossa from SNAC wrist; B. Cadaver meniscus used to resurface the defect and joint space and was inset with vicryl suture and fibrin glue.

Figure 2. A. Patient 9, preoperative X-rays of right wrist displaying Scaphoid Nonunion Advanced Collapsed osteoarthritis.
B. Postoperative x-rays of right wrist after proximal row carpectomy and cadaver meniscus resurfacing of radiolunate fossa and capitate.

Figure 3. Intraoperative view of tenolysis and capsulotomy 19 months after cadaver meniscus 2nd MCP joint resurfacing revealing intact joint surfaces.

Figure 4. A. 67 year-old female with non-traumatic osteoarthritis, 6-months postoperative from 2nd PIP joint reconstruction with cadaver meniscus (AP view); B. Lateral view of reconstructed joint; C. Improved range of motion, 60 degrees flexion at PIP joint from 0 preoperatively.

Table 1.

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