Clinical Outcome and Histologic Findings of Costal Osteochondral Grafts for Cartilage Defects in Finger Joints

doi:10.1016/j.jhsa.2008.01.003

The Journal of Hand Surgery

Volume 33, Issue 4, April 2008, Pages 511-515

https://doi.org/10.1016/j.jhsa.2008.01.003 Get rights and content

Purpose

For the purpose of achieving anatomical reduction as precisely as possible, we performed osteochondral grafting from the costo-osteochondral junction in 16 patients (17 joints) with posttraumatic articular cartilage injury or avascular necrosis in finger joints. The purpose of this study was to review our series of costal osteochondral grafts in order to determine the practicality, effectiveness, and functionality of this grafting technique in a clinical setting.

Methods

Patients were followed for at least 18 months postoperatively (18–57 months; average, 28 months). The injured joints included 3 metacarpophalangeal, 9 proximal interphalangeal, 3 distal interphalangeal, and 2 thumb interphalangeal joints. The defect accounted for 50% to 100% of the articular surface (average, 63%).

Results

The average time until bone union of the graft was 58 days. The mean arc of motion was 13° before surgery versus 58° after surgery, with a mean increase of 45°. In 7 patients (8 joints), an extremely small portion (approximately 1 × 1 mm in size and thinner than 0.1 mm) of the implanted cartilage was obtained via biopsy using a scalpel with the consent of the patient at the time of screw removal and was used to prepare histologic specimens, which revealed scattered chondrocytes within the matrix without differences from normal hyaline cartilage in any. The chondrocytes in the grafts appeared viable, and the reconstruction of the joint surface could be confirmed histologically.

Conclusions

Osteochondral grafting from the costo-osteochondral junction achieves excellent reconstruction of the injured joint without affecting other joints. This technique is particularly beneficial in cases where it is difficult to obtain allograft donors, as is often the case in Japan. Despite these encouraging findings in this small series, we believe that it is necessary to conduct further studies of this method over a longer period.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

Sixteen patients (17 joints) had costal osteochondral grafting since August 1997. The interval between injury and operation ranged from 2 days to 40 years, and the duration of postoperative follow-up was 18 to 57 months (average, 28 months).

All patients were men, ranging in age from 18 to 68 years (average, 37 years). The causes of injuries were occupational accidents in 9, traffic accidents in 4, and other accidents in 3. The injured digits comprised 2 thumbs, 2 index fingers, 3 middle

Results

The defects accounted for 50% to 100% (average, 63%) of the entire articular surface (Table 1). A part of the costo-osteochondral junction was harvested to reconstruct the cartilage defects in 9 of 16 cases, and the whole of the junction was needed in 7 cases (cases 1, 3, 4, 5, 6, 12, and 13). Implanted grafts resulted in bone union in all of the patients, and the average time until bone union was 58 days. Fourteen patients were pain free at the time of final evaluation, but the remaining 2

Discussion

Although new methods using tissue-engineering techniques have been reported, osteochondral grafting is still a reliable procedure to repair disordered joint surfaces,1, 2, 3, 4, 5 and there is general agreement that this technique provides relatively satisfactory results.

In many of the previous studies, allografts or autografts harvested from non–weight-bearing areas of affected or unaffected knee joints were used. Munro et al⁶ reported the viability of osteochondral grafts harvested from the

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Cited by (43)

Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint
2023, Journal of Hand Surgery
Citation Excerpt :
For reconstruction of a focal defect in the central portion of the base of the middle phalanx, there are multiple donor resources that can be used as an autograft. The previously reported donor sites include the metacarpophalangeal and knee joints and the costal osteochondral tissue.4,5,7,24 Although functional recovery was generally satisfactory after the reconstructive procedures, the harvest of these osteochondral grafts was technically demanding.
The management of a proximal interphalangeal (PIP) joint fracture dislocation becomes more challenging when the joint surface is damaged because of severe comminution or inadequate treatment in the acute phase. The purpose of this study was to evaluate the clinical outcomes of an osteochondral autograft for the reconstruction of the joint surface in patients with a partial PIP joint defect.
Twelve patients underwent osteochondral autograft surgery from May 2007 to July 2018. The average age at the time of surgery was 38 years (range, 21–67 years), and there were 10 men and 2 women. Plain radiographs and computed tomography scans showed a partial middle phalangeal base defect in all the cases. The surgeries were performed 2 weeks to 20 months after the fracture or a previous surgery. Partial hamate grafts were harvested to reconstruct volar lip (n = 7), middle portion (n = 2), and dorsal lip (n = 3) defects of the middle phalangeal base. Bone healing, postoperative range of motion, instability, and pain were evaluated. The average follow-up duration was 27.8 months (range, 12–53 months).
Radiographic graft union was observed in all the patients 6–8 weeks after the surgery. The deformity was corrected in 11 patients. The active range of motion of the involved PIP joint was improved from 28.3° (range, 0°–60°) to 75.0° (range, 25°–95°). Complications were observed during follow-up, including degenerative arthritis (n = 2), instability (n = 3), and stiffness (n = 5).
Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. The functional recovery is generally acceptable, with a well-restored joint architecture.
Therapeutic IV.
Biofunctional Materials for Bone and Cartilage Tissue Engineering
2021, Encyclopedia of Smart Materials
Regenerative medicine is a promising new area of research that offers potential to treat diseased and injured tissue. In particular, the development of new biomaterial-based approaches shows promise for the treatment of challenging bone and cartilage injuries. Recent trends have focused on the development of biofunctional materials that have bioactive properties and are capable of supporting and promoting new tissue formation during the tissue repair process. This article discusses current biomaterial-based approaches for bone and cartilage repair and highlights emerging material functionalization methodologies including surface modification, growth factor delivery, cell-seeding strategies and gene therapy.
The human costal cartilage: Anatomical and radiological study of macro-vascularization and micro-vascularization and its clinical relevance regarding vascularized chondrocostal free flap surgery
2020, Annals of Anatomy
Cartilage repair usually involves in non-vascularized osteochondral or chondral grafts with some drawbacks potentially linked to the lack of vascular supply in those grafts. The aim of this study was to describe a surgical approach for harvesting a vascularized chondrocostal graft, to study the vascular supply to the perichondrium and finally to describe the perichondrium micro-vascularization in order to know how such grafts could be used in cartilage repair surgery.
We harvested and studied 18 costal cartilages harvested from 12 fresh anatomical subjects. The anatomic pieces were injected with a radio-opaque tracer, analyzed macroscopically, then a plain X-rays and CT scan analysis with three-dimensional rendering was performed in order to evaluate the characteristics of the different patterns of their vascularization.
The surgical approach to harvest a vascularized 5th chondrocostal graft is explained in detail. All of the cartilages were vascularized by the internal thoracic artery and harvested with a pedicle of an average length of 34 mm and diameter of 2.14 mm. In all specimens, perichondrium vascularization arises from both superior and inferior intercostal branches. Anastomoses between inferior and superior intercostal branches are always found in all specimens at the level of the epichondrium.
The anatomic approach for harvesting a vascularized chondrocostal graft is simple and only slightly differs from the approach described for harvesting a non-vascularized chondrocostal graft. The vascular supply to the perichondrium of such a vascularized chondrocostal graft is sustained by the internal thoracic vessels which have a sufficient diameter and length to allow easy micro-anastomosis. The organization of the micro-vasculature within the perichondrium allows the graft to be tailored to a large cartilage defects and also to small bipolar cartilage defects.
Chondrocostal grafting for lateral osteochondral injury of the metacarpal head
2020, Orthopaedics and Traumatology: Surgery and Research
Osteochondral injuries of the metacarpal head require anatomical restoration to prevent limitations in range of motion and osteoarthritis. Osteochondral bone grafting is a viable option, especially in younger patients. Central injuries allow for different types of grafting, but when the injured area is on the lateral portion of the metacarpal head, the graft must include both a cortical and a cartilaginous portion. We present here the pearls and pitfalls in the surgical technique of chondrocostal grating from the 6th rib and an example of its use within a case of comminuted fracture of the metacarpal head. This technique provides a graft with cortical bone that allows for a stable fixation, with few complications during its harvesting. The graft is viable in the long-term and shows similar magnetic resonance intensities in comparison to hand cartilage.
Joint Fusion and Arthroplasty in the Hand
2019, Clinics in Plastic Surgery
Technical note on the harvesting of rib osteochondral autografts for upper limb bone and joint repair surgery
2018, Hand Surgery and Rehabilitation
Rib cartilage grafts are widely used in maxillofacial surgery, but not in orthopedic surgery. The aim of this technical note is to describe the technique used to harvest this graft and to report on donor site complications in the 136 cases we have published on up to now. Harvesting is carried out at the osteochondral junction of the eighth rib. The osteochondral junction is located under the external oblique muscle and a perichondrium layer, which is retracted to allow safe harvesting. The amount of cartilage harvested depends on the size of the area being grafted. Harvesting of a rib osteochondral graft is easy to carry out, provides a considerable amount of hyaline cartilage for the reconstruction of degenerative and traumatic lesions on a joint surface and results in few donor site complications.
La greffe de cartilage costal est largement utilisée en chirurgie maxillo-faciale, beaucoup moins en orthopédie. Le but ici est d’expliquer la technique du prélèvement d’une telle greffe et de rapporter les complications au niveau du site donneur par une revue de nos 136 cas publiés. Le prélèvement est réalisé au niveau de la jonction ostéo-cartilagineuse de la 8^e côte. La jonction ostéo-cartilagineuse est trouvée sous le muscle oblique externe et un feuillet de périchondre, récliné pour permettre le prélèvement en sécurité. La quantité de cartilage prélevée est choisie à la demande en fonction de la surface à greffer. Le prélèvement d’un greffon osteochondral de côte est une technique facile à réaliser, permet d’apporter une quantité intéressante de cartilage hyalin pour reconstruire une surface articulaire atteinte d’une lésion dégénérative ou traumatique et donne peu de complications au niveau du site donneur.

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: The authors greatly appreciate Dr. Clayton A. Peimer for his contribution to revising the manuscript.

: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Scientific articleClinical Outcome and Histologic Findings of Costal Osteochondral Grafts for Cartilage Defects in Finger Joints

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

Arthroscopy

Osteoarthritis Cartilage

J Hand Surg

J Hand Surg

J Shoulder Elbow Surg

Scientific article
Clinical Outcome and Histologic Findings of Costal Osteochondral Grafts for Cartilage Defects in Finger Joints