Successful Arthroplasty Using Cadaveric Meniscus for Osteochondral Defects in the Wrist and Hand Joints

Abstract

Background:Osteochondral defects of the radiocarpal, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) 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 intraarticular contact stress.Methods:A total of 14 patients with osteochondral defects in 5 radiocapitate, 5 MCP, 3 PIP, and 1 carpometacarpal joints received cadaveric meniscus to facilitate arthroplasty. Patient demographic, perioperative pain, range of motion, and complications were examined.Results:Patients aged 17 to 73 years old (average, 54.6 years old) underwent joint reconstruction for scaphoid nonunion (n = 1), scaphoid-lunate advanced collapse (n = 4), or osteoarthritis of MCP/carpometacarpal (n = 6) or PIP (n = 3) joints. Successful arthroplasty with joint space preservation occurred in all joints. Patients had a significant reduction in average pain scale score (P < 0.01) and improved average range of active motion degrees of flexion (P < 0.01) and degrees of extension (P < 0.05). No complications resulted; only a revision tenolysis and capsulotomy were required for PIP and MCP arthroplasties. Postoperative films reveal preservation of arthroplasty joint space after an average 19.7-month follow-up (range, 8–54).Conclusions:We believe that meniscus is a viable joint salvage option or adjunct to preserve pain-free motion and avoid total joint arthrodesis. In this series of 14 patients, we demonstrate the successful use of cadaver meniscus in hand joint arthroplasty, such that it advantageously maintains a low metabolic demand, is biointegratable, and is surgically malleable.

Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand

“… 22 Although predominantly used in the lower extremity, Nanavati et al 23 first described the use of MAT for proximal carpectomy in the hand. More recently, Shapiro et al 24 described the use of MAT for interposition arthroplasty in trapeziometacarpal arthritis, and Hoang et al 25 described it for resurfacing of metacarpal phalangeal and proximal interphalangeal joints of the hand. However, further studies regarding clinical outcomes are lacking.…”

Functional Outcomes for Basilar Joint Arthroplasty with Meniscus Allograft Compared with Trapeziectomy Alone

“…28 While predominantly used in the lower extremity, Nanavati et al 30 first described the use of MAT for proximal carpectomy in the hand. More recently, Shapiro et al 31 described the use of MAT for interposition arthroplasty in CMC arthritis, and Hoang et al 32 described it for resurfacing of metacarpal phalangeal and proximal interphalangeal joints of the hand. However, further studies regarding clinical outcomes, including strength and range of motion measures, as well as patient-reported pain and disability scores, are lacking.…”

Cadaveric Meniscus Arthroplasty for Post-Traumatic Arthritis: A Case Report

“…In recent years, interest has developed around the use of meniscus allograft for joint resurfacing of the thumb carpometacarpal (CMC) joint as an alternative approach to maintaining joint architecture and motion while avoiding many of the complications inherent to prosthetic implants. 4 , 5 , 6 , 7 We present a novel case of application of this technique for post-traumatic arthritis of the fifth CMC joint in a young patient.…”