Department of Orthopedic Surgery, Gyeongsang National University, College of Medicine and Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Republic of Korea.
Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2023 Jan 20;102(3):e32563. doi: 10.1097/MD.0000000000032563.
Osteochondral autograft transplantation surgery (OATS) was introduced as a treatment for hand osteochondritis dissecans (OCD), and successful results were reported. However, the cartilage height of the donor plug has not yet been established compared with that of other joints. We present a case using OATS for OCD of the 3rd metacarpal (MCP) head that occurred in a soldier and the findings of magnetic resonance imaging (MRI) images taken at 12 weeks after surgery.
A 21-year-old male presented with a painful, swollen 3rd MCP joint in the right hand. He was a soldier and right-handed; in addition, he did not recall any traumatic events, nor had he taken any corticosteroid medications before. The patient was excluded from military training and underwent conservative treatment with medication and a brace in a military hospital for 3 months.
The patient was diagnosed with OCD due to avascular necrosis of the 3rd MCP head of the right hand through X-ray and MRI.
OATS was planned as a surgical treatment. Surgery uncovered a 10 × 10 mm2, isolated cartilage defect of the 3rd MCP head that had an irregular margin and a loose body. Using Arthrex OATS, a 10-mm diameter, 10-mm depth hole was made at the articular defect site, and an 11-mm diameter, 12-length plug was harvested from the left lateral femoral condyle. The donor plug was inserted into the prepared defect site with press-fit fixation.
At the last follow-up, the height of the articular cartilage had subsided with union on MRI 12 weeks after the surgery. However, the patient was asymptomatic with a normal range of motion of the right hand, and he returned to military training.
Although the joints of the hand are small and non-weight bearing, the level of articular cartilage of the donor plug was subsided in a follow-up MRI in our case. We suggest that the difference in cartilage thickness between the donor and the recipient might have been the cause of subsidence of the articular cartilage, and therefore, it may be helpful to transplant donors with similar thicknesses of articular cartilage.
骨软骨自体移植手术（OATS）被引入治疗手部骨软骨炎（OCD），并取得了成功的结果。然而，与其他关节相比，供体移植物的软骨高度尚未确定。我们报告了一例士兵手部第三掌骨（MCP）头 OCD 患者使用 OATS 治疗的病例，并介绍了术后 12 周的磁共振成像（MRI）图像结果。
一名 21 岁男性右手第三 MCP 关节出现疼痛、肿胀。他是一名士兵，惯用右手；此外，他不记得有任何创伤事件，也没有服用过皮质类固醇药物。该患者被排除在军事训练之外，并在一家军事医院接受药物和支具的保守治疗 3 个月。
通过 X 射线和 MRI，患者被诊断为右手第三 MCP 头缺血性坏死性 OCD。
计划采用 OATS 进行手术治疗。手术揭示了第三 MCP 头有一个 10×10mm2 的孤立性软骨缺损，边缘不规则，有游离体。使用 Arthrex OATS，在关节缺损部位钻一个 10mm 直径、10mm 深度的孔，从左侧股骨外侧髁取一个 11mm 直径、12mm 长的移植物。将供体移植物以压配合固定的方式插入准备好的缺损部位。
术后 12 周的 MRI 显示，关节软骨的高度已经下降，出现愈合。然而，患者无症状，右手活动范围正常，他已经恢复了军事训练。
虽然手部关节较小且无承重，但在我们的病例中，术后 MRI 显示供体移植物的关节软骨高度下降。我们认为，供体和受体之间软骨厚度的差异可能是导致关节软骨下降的原因，因此，移植具有相似关节软骨厚度的供体可能会有所帮助。
