Arthroscopic Transplantation of Osteochondral Autograft for Treatment of Cartilage Defects in the Wrist

Abstract

Focal chondral lesion is a common cause of chronic wrist pain after trauma. While small lesions usually respond well to drill chondroplasty, larger lesions can be treated with arthroscopic transplantation of osteochondral autograft from the knee joint to the distal radius with satisfactory clinical result. With a 1.9 mm or 2.7 mm arthroscope in the 3–4 portal, synovitis over the dorsal lunate fossa is debrided to uncover the underlying osteochondral lesion. A 4.75 or 6 mm trephine of the Osteoarticular Transfer System (OATS) can be inserted through the 3–4 portal to remove the osteochondral defect for a length of 10–12 mm under direct arthroscopic vision at the 4–5 portal. An osteochondral graft of the same dimension is harvested from the lateral femoral condyle and delivered into the wrist joint arthroscopically. It is essential to maintain a vertical trajectory during the graft insertion. Graft fixation is stable so no immobilization of the wrist is required. Passive motion exercise can be initiated by 4–6 weeks. Grafts incorporation is completed by 3–4 months post-operation. At the final follow-up of average 70.5 months (range 24–116), all 4 patients in a series showed improvement in the wrist performance score (pre-op 27.5, post-op 38.5 out of 40) and pain score (pre-op 9.5, post-op 0.5 out of 20). Grip strength improved from 62.6 to 91.1% on the contra-lateral side. Motion arc improved from 115.5° to 131.3°. X-ray showed no arthrosis. Patient satisfaction was high with no complications.