Download PDF
J Wrist Surg 2013; 02(03): 206-211
DOI: 10.1055/s-0033-1350084
Special Focus
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Technique: Osteochondral Grafting of Capitate Chondrosis in PRC

Peter Tang
1   Allegheny Health Network, Pittsburgh, Pennsylvania
,
Joseph E. Imbriglia
2   Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
3   Western Pennsylvania Hand and UpperEx Center, Wexford, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
05 September 2013 (online)

   Permissions and Reprints

Abstract

Background Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones.

Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre- and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated.

Description of Technique The articular surface of the capitate is assessed for need for grafting. The proximal row is resected with the lunate removed intact. The arthritic area is prepared. The graft is taken from the lunate and placed in the prepared site of the capitate.

Results Eight patients (average age of 53 years) were followed for 18 months. Pain: Preoperatively, moderate to severe in 7 patients; postoperatively, mild to no pain in 7 patients. Motion: Preoperative, 84° (74% of the contralateral side); postoperative 75° (66%). Grip Strength: Preoperative, 29 kg (62%); postoperative, 34 kg (71%). Mayo Wrist Score: Preoperative, 51 (poor); postoperative, 68 (fair). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration.

Conclusions Osteochondral grafting in PRC offers satisfactory results in terms of pain relief, return to work, motion, and grip strength.

Level of Evidence Therapeutic IV, Case series

Keywords

osteochondral graft - proximal row carpectomy
 

  • References

  • 1 Green DP. Proximal row carpectomy. Hand Clin 1987; 3 (1) 163-168
    PubMedGoogle Scholar
  • 2 Crabbe WA. Excision of the proximal row of the carpus. J Bone Joint Surg Br 1964; 46: 708-711
    PubMedGoogle Scholar
  • 3 Inglis AE, Jones EC. Proximal-row carpectomy for diseases of the proximal row. J Bone Joint Surg Am 1977; 59 (4) 460-463
    Google Scholar
  • 4 Imbriglia JE, Broudy AS, Hagberg WC, McKernan D. Proximal row carpectomy: clinical evaluation. J Hand Surg Am 1990; 15 (3) 426-430
    CrossrefPubMedGoogle Scholar
  • 5 Culp RW, McGuigan FX, Turner MA, Lichtman DM, Osterman AL, McCarroll HR. Proximal row carpectomy: a multicenter study. J Hand Surg Am 1993; 18 (1) 19-25
    CrossrefPubMedGoogle Scholar
  • 6 Jebson PJL, Hayes EP, Engber WD. Proximal row carpectomy: a minimum 10-year follow-up study. J Hand Surg Am 2003; 28 (4) 561-569
    CrossrefPubMedGoogle Scholar
  • 7 DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am 2004; 86-A (11) 2359-2365
    PubMedGoogle Scholar
  • 8 Neviaser RJ. Proximal row carpectomy for posttraumatic disorders of the carpus. J Hand Surg Am 1983; 8 (3) 301-305
    CrossrefPubMedGoogle Scholar
  • 9 Neviaser RJ. On resection of the proximal carpal row. Clin Orthop Relat Res 1986; 202 (202) 12-15
    PubMedGoogle Scholar
  • 10 Salomon GD, Eaton RG. Proximal row carpectomy with partial capitate resection. J Hand Surg Am 1996; 21 (1) 2-8
    CrossrefPubMedGoogle Scholar
  • 11 Salon A, Hémon C. Conservative surgery in Kienböck disease with perilunate arthrosis: articular resurfacing using resected carpal bones [in French]. Chir Main 2003; 22 (3) 154-157
    CrossrefPubMedGoogle Scholar
  • 12 Langer MF, Wieskötter B, Vordemvenne T, Surke C. Osteochondral reconstruction of the lunate fossa in proximal row carpectomy for Kienböck's disease early stage IV [in German]. Handchir Mikrochir Plast Chir 2010; 42 (3) 212-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Tang P, Imbriglia JE. Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy. J Hand Surg Am 2007; 32 (9) 1334-1342
    CrossrefPubMedGoogle Scholar
  • 14 Thorngren KG, Werner CO. Normal grip strength. Acta Orthop Scand 1979; 50 (3) 255-259
    PubMedGoogle Scholar
  • 15 Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (6) 602-608
    CrossrefPubMedGoogle Scholar
  • 16 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; 214 (214) 136-147
    PubMedGoogle Scholar
  • 17 Harris WH, Jones WN, Aufranc OE. Problem Cases from Fracture Grand Rounds at the Massachusetts General Hospital. St. Louis, MO: Mosby; 1965: 291
    Google Scholar
  • 18 Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?. J Hand Surg Am 1994; 19 (1) 134-142
    CrossrefPubMedGoogle Scholar
  • 19 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (1) 94-104
    CrossrefPubMedGoogle Scholar
  • 20 Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am 1995; 20 (6) 965-970
    CrossrefPubMedGoogle Scholar
  • 21 Tomaino MM, Delsignore J, Burton RI. Long-term results following proximal row carpectomy. J Hand Surg Am 1994; 19 (4) 694-703
    CrossrefPubMedGoogle Scholar
  • 22 Yamashita F, Sakakida K, Suzu F, Takai S. The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee. Clin Orthop Relat Res 1985; 201 (201) 43-50
    PubMedGoogle Scholar
  • 23 Görtz S, Bugbee WD. Allografts in articular cartilage repair. J Bone Joint Surg Am 2006; 88 (6) 1374-1384
    PubMedGoogle Scholar
  • 24 Lane JM, Brighton CT, Ottens HR, Lipton M. Joint resurfacing in the rabbit using an autologous osteochondral graft. J Bone Joint Surg Am 1977; 59 (2) 218-222
    PubMedGoogle Scholar
  • 25 Lane JG, Tontz Jr WL, Ball ST , et al. A morphologic, biochemical, and biomechanical assessment of short-term effects of osteochondral autograft plug transfer in an animal model. Arthroscopy 2001; 17 (8) 856-863
    PubMedGoogle Scholar
  • 26 Siebert CH, Miltner O, Weber M, Sopka S, Koch S, Niedhart C. Healing of osteochondral grafts in an ovine model under the influence of bFGF. Arthroscopy 2003; 19 (2) 182-187
    PubMedGoogle Scholar
  • 27 Nam EK, Makhsous M, Koh J, Bowen M, Nuber G, Zhang LQ. Biomechanical and histological evaluation of osteochondral transplantation in a rabbit model. Am J Sports Med 2004; 32 (2) 308-316
    CrossrefPubMedGoogle Scholar
  • 28 Burks RT, Greis PE, Arnoczky SP, Scher C. The use of a single osteochondral autograft plug in the treatment of a large osteochondral lesion in the femoral condyle: an experimental study in sheep. Am J Sports Med 2006; 34 (2) 247-255
    CrossrefPubMedGoogle Scholar
  • 29 Harman BD, Weeden SH, Lichota DK, Brindley GW. Osteochondral autograft transplantation in the porcine knee. Am J Sports Med 2006; 34 (6) 913-918
    CrossrefPubMedGoogle Scholar
  • 30 Nakaji N, Fujioka H, Nagura I , et al. The structural properties of an osteochondral cylinder graft-recipient construct on autologous osteochondral transplantation. Arthroscopy 2006; 22 (4) 422-427
    PubMedGoogle Scholar
  • 31 Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sports Med 2001; 20 (3) 565-590
    CrossrefPubMedGoogle Scholar
  • 32 Tsuda E, Ishibashi Y, Sato H, Yamamoto Y, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the capitellum in nonthrowing athletes. Arthroscopy 2005; 21 (10) 1270
    PubMedGoogle Scholar
  • 33 Lee CH, Chao KH, Huang GS, Wu SS. Osteochondral autografts for osteochondritis dissecans of the talus. Foot Ankle Int 2003; 24 (11) 815-822
    CrossrefPubMedGoogle Scholar
  • 34 Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 25-32
    PubMedGoogle Scholar
  • 35 Alford JW, Cole BJ. Cartilage restoration, part 1: basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med 2005; 33 (2) 295-306
    CrossrefPubMedGoogle Scholar
  • 36 Alford JW, Cole BJ. Cartilage restoration, part 2: techniques, outcomes, and future directions. Am J Sports Med 2005; 33 (3) 443-460
    CrossrefPubMedGoogle Scholar
  • 37 Barber FA, Chow JC. Arthroscopic osteochondral transplantation: histologic results. Arthroscopy 2001; 17 (8) 832-835
    PubMedGoogle Scholar
  • 38 Ishida O, Ikuta Y, Kuroki H. Ipsilateral osteochondral grafting for finger joint repair. J Hand Surg Am 1994; 19 (3) 372-377
    CrossrefPubMedGoogle Scholar
  • 39 Boulas HJ. Autograft replacement of small joint defects in the hand. Clin Orthop Relat Res 1996; 327 (327) 63-71
    CrossrefPubMedGoogle Scholar
  • 40 Gaul Jr JS. Articular fractures of the proximal interphalangeal joint with missing elements: repair with partial toe joint osteochondral autografts. J Hand Surg Am 1999; 24 (1) 78-85
    CrossrefPubMedGoogle Scholar
  • 41 Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am 2003; 28 (5) 856-865
    CrossrefPubMedGoogle Scholar
  • 42 Glard Y, Gay A, Valenti D, Berwald C, Guinard D, Legre R. Costochondral autograft as a salvage procedure after failed trapeziectomy in trapeziometacarpal osteoarthritis. J Hand Surg Am 2006; 31 (9) 1461-1467
    CrossrefPubMedGoogle Scholar
  • 43 Sandow MJ. Proximal scaphoid costo-osteochondral replacement arthroplasty. J Hand Surg Br 1998; 23 (2) 201-208
    PubMedGoogle Scholar
  • 44 Lackman RD, McDonald DJ, Beckenbaugh RD, Sim FH. Fibular reconstruction for giant cell tumor of the distal radius. Clin Orthop Relat Res 1987; 218 (218) 232-238
    PubMedGoogle Scholar
  • 45 Mehin R, Giachino AA, Backman D, Grabowski J, Fazekas A. Autologous osteoarticular transfer from the proximal tibiofibular joint to the scaphoid and lunate facets in the treatment of severe distal radial fractures: a report of two cases. J Hand Surg Am 2003; 28 (2) 332-341
    CrossrefPubMedGoogle Scholar