Hess Daniel E, Werner Brian C, Deal D Nicole
1 University of Virginia, Charlottesville, USA.
2 Hospital for Special Surgery, New York, NY, USA.
Hand (N Y). 2017 Sep;12(5):NP62-NP67. doi: 10.1177/1558944716673047. Epub 2016 Oct 11.
Articular cartilage injuries are a common injury among young, active patients, and the most appropriate treatment for these injuries remains controversial. A promising new technology in the treatment of high-grade cartilage injuries is particulated juvenile articular cartilage (PJAC) allograft (DeNovo NT, Zimmer, Warsaw, Indiana). This has been shown to be successful in multiple joints including the knee, talus, and elbow. No studies or case reports exist in supporting or discouraging its use in injuries of the wrist, in specific, the scaphoid.
The use of PJAC allograft is described for the treatment of an active 21-year-old male with an Outerbridge Grade IV chondral lesion on the proximal pole of his right scaphoid and right distal radius scaphoid facet who had failed conservative management. The patient was followed clinically and radiographically for 21 months.
The patient had return to full sport (jujutsu) and full range-of-motion, both of which represented an improvement from his preoperative exam. Radiographically, the chondral lucency seen had decreased in size and was almost completely absent on radiographs after 21 months.
The results of this case suggest that PJAC can be used safely and effectively in the wrist thereby potentially broadening the indications for its use.
关节软骨损伤在年轻、活跃的患者中较为常见，而针对这些损伤的最合适治疗方法仍存在争议。治疗高级别软骨损伤的一项有前景的新技术是颗粒状青少年关节软骨（PJAC）同种异体移植（DeNovo NT，齐默公司，印第安纳州华沙）。这已被证明在包括膝关节、距骨和肘关节在内的多个关节中取得成功。目前尚无研究或病例报告支持或反对其在腕部损伤，特别是舟骨损伤中的应用。
描述了使用PJAC同种异体移植治疗一名21岁活跃男性的情况，该患者右舟骨近端极及右桡骨远端舟骨关节面存在外布里奇IV级软骨损伤，保守治疗失败。对该患者进行了21个月的临床和影像学随访。
患者恢复了全面运动（柔术）且活动范围完全恢复，这两者均较术前检查有所改善。影像学上，观察到的软骨透亮区大小减小，21个月后X线片上几乎完全消失。
该病例结果表明，PJAC可安全有效地用于腕部，从而可能扩大其应用指征。
