Costal Osteochondral Graft Research Articles

A Comparison of Rib Osteochondral Graft to Medial Femoral Trochlear Osteocartilaginous Graft for the Salvage of the Fragmented Scaphoid Proximal Pole: A Single-Center Experience with Minimum 2-Year Follow-Up.

Purpose Fragmented fractures of the proximal pole of the scaphoid that cannot be internally fixed may be salvaged by four-corner arthrodesis or proximal row carpectomy. Replacement of the proximal scaphoid with costal-osteochondral graft (COG) or the medial femoral trochlea (MFT) graft are two alternative solutions for this clinical presentation. The purpose of this study was to compare the clinical and radiographic results of the COG and the MFT graft with a minimum 2-year follow-up from a single centre. Methods A retrospective study was performed to investigate the outcome of COG and MFT with a minimum 2 year follow up. Demographic data and clinical assessment including wrist range of motion and grip strength measurements and Oxford Knee score were collected. Patients completed the outcome measures of Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a ten-point visual analogue score for pain (VAS). Radiological examination was performed on all wrists at follow-up. Results The visual analogue score, DASH and PRWE were similar between the two groups. There was radiographic evidence of arthritis between the radial styloid and distal scaphoid in all patients that underwent COG but no evidence in those that underwent MFT graft reconstruction. There were different complications in each group. Thirty percent of patients that underwent MFT reconstruction had persistent knee pain at follow up. Conclusion Though there are notable differences in the follow-up period, patients undergoing MFT risk developing knee pain, while those undergoing COG risk radiographic progression of wrist arthritis. Level of Evidence III - Comparative study.

The regenerative treatment of costal osteochondral graft implantation for partial growth arrest using a rabbit model

PurposeTo investigate the feasibility of cylindrical costal osteochondral graft transplantation as a novel regenerative treatment in growth arrest. MethodsThe medial portion of the proximal tibial growth plate of 6-week-old male New Zealand White rabbits was resected to establish an experimental model of partial growth plate injury. The rabbits were divided into four groups: no-treatment, bone wax transplantation, costal chondral graft, and costal osteochondral graft groups. Radiographic and micro-computed tomography scan results were analyzed to evaluate angular deformity of the tibia and bony bridge formation at the injury site. In addition, repair of the injured growth plate cartilage was assessed histologically at 4, 8, and 12 weeks postoperatively. ResultsRadiographic examination revealed that bone wax transplantation continuously decreased the medial proximal tibial angle (MPTA) while the costal chondral graft implantation reduced the decrease of MPTA at 12 weeks postoperatively. The costal osteochondral graft implantation recovered the MPTA, close to the normal. Histologically, the costal osteochondral grafts retained the MPTA in the injured site compared to costal chondral grafts. Additionally, hypertrophic chondrocytes were observed at the graft site in the costal osteochondral graft group at 12 weeks, suggesting that endochondral ossification may occur at the graft site similar to normal ossification. The fluorescence in situ hybridization analysis of osteochondral grafts transplanted from male to female rabbits indicated that they were replaced by cells of host origin. ConclusionThe costal osteochondral graft can achieve regeneration without bony bridge formation in partial growth plate injury.

Use of a Box-cut Osteotomy Preserving Collateral Ligaments in Costal Osteochondral Graft Reconstruction of Proximal Interphalangeal Joint Cartilage Defects.

We report two patients with reconstruction of osteochondral defects of the proximal interphalangeal joint (PIPJ) using a costal osteochondral graft (COG). A box-cut osteotomy was done at the end of the phalanx preserving the lateral cortices and the insertion of the collateral ligaments. A COG was harvested from the rib, moulded and press fit into the groove formed by the box-cut osteotomy. The COG was fixed with mini screws in the coronal plane (dorsal to palmar) and the fixation off-loaded with an external fixator. This technique maintained the collateral ligament in-situ and is useful in reconstruction of chondral defects of the PIPJ. Level of Evidence: Level V (Therapeutic).

Three-and-a-half to 18 year outcome data for costal osteochondral grafts for salvage of the proximal pole of the scaphoid

Twelve patients who had undergone costal osteochondral graft reconstruction of the proximal pole of scaphoid were evaluated with clinical examination, patient-reported outcome scores and radiographs with an average follow-up of 10 years (range 3.5-18). The range of wrist motion was not significantly changed compared with the preoperative range of motion and functional outcomes scores were acceptable. The patients reported low pain scores despite the universal presence of radiographic changes of reduced carpal height and arthritis of the midcarpal and radiocarpal joints. Costal osteochondral graft reconstruction of the proximal pole of scaphoid offers good long-term pain relief and function.Level of evidence: IV.

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Total Finger Arthroplasty Using Costal Osteochondral Autograft for Finger Joint Ankylosis: Mid- to Long-Term Clinical Outcomes Up to 11 Years of Follow-Up

There is no financial information to disclose. Costal osteochondral grafting is a technique for providing anatomical and biological reconstruction of articular disorders. We have applied this procedure to the treatment of finger joint ankylosis. The purpose of this study was to clarify the mid- to long-term clinical outcomes of total finger arthroplasty using costal osteochondral autograft for finger joint ankylosis. The metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were approached dorsally through a longitudinal incision. The periosteum and capsule were elevated concurrent with the collateral ligaments and the volar plate all around the joint (Figure 62-1A). The ankylosed joint was separated at the original joint level. The ends of the phalanx and metacarpus were step-cut for the graft floor (Figure 62-1B). Two pieces of osteochondral graft were harvested from the fifth and sixth ribs and then manually trimmed to form a new MCP/PIP joint with adequate contours using a scalpel (Figure 62-1C). The bony part of the graft was step-cut and stabilized using low-profile screws (Figure 62-1D). Twenty-three finger joints (3 MCP joints and 20 PIP joints) in 23 patients with ankylosis were treated with costal osteochondral autograft with at least 5 years of follow-up. Participants were composed of 19 males and 4 females ranging in age from 18 to 55 years (mean, 33 years). Clinical outcomes including range of finger motion, the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder, and Hand (DASH-JSSH) score, donor-site disturbances, and radiographic outcomes were evaluated after a mean follow-up of 77 months (range, 60–138 months). Significant improvement in active finger extension-flexion was seen from a preoperative mean of –24°/26° (arc: 2°) to –12°/75° (arc: 63°) at 1 year postoperatively (P < .001) and to –13°/75° (arc: 62°) at latest follow-up (P < .001). Mean preoperative DASH-JSSH score was initially 23.6, improving significantly to 6.6 at 1 year postoperatively, and to 5.2 by latest follow-up (P < .001) (Figure 62-2). Donor-site pain persisted only 1 to 2 weeks after surgery and raised no particular problems. One patient injured the operated finger while playing rugby football 2 years after surgery and needed additional costal osteochondral grafting. Other additional surgeries were collateral ligament reconstruction in 4 patients, corrective osteotomy of the phalanx in 2, and tenolysis in 1. •Total finger arthroplasty using costal osteochondral autograft for finger joint ankylosis showed anatomical and biological reconstruction and provided stable improvement of clinical outcomes with a mean follow-up of 77 months.Figure 62-1BAfter exposure of the ankylosed joint, the bone is separated with a chisel at the original PIP joint. The cut-off ends of the middle and proximal phalanx are step-cut.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 62-1CTwo pieces of osteochondral graft are harvested from the fifth and sixth ribs through an ipsilateral transverse sub-mammary incision. The harvested grafts are trimmed by hand to form the head of the proximal phalanx and base of the middle phalanx. The cartilaginous area of the graft is trimmed using a scalpel. Careful trimming is necessary to form adequate contours.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 62-1DThe bony part of the graft is step-cut and stabilized using low-profile screws. In closure, the central slip is reattached to the base of middle phalanx, and the collateral ligament, periosteum, and volar plate are repaired with 5-0 nylon sutures. A continuous distracting device is applied to the PIP joint to decrease friction between the joint surfaces.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 62-2Comparing range of motion preoperatively, at 1 year postoperatively, and at latest follow-up. *P < .001.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Costal Osteochondral Autograft for Advanced Osteochondritis Dissecans of the Humeral Capitellum in Adolescent and Young Adult Athletes: Clinical Outcomes with a Mean Follow-up of 4.8 Years.

Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The purpose of this study was to clarify longer-term clinical outcomes of costal osteochondral autografts in the treatment of advanced osteochondritis dissecans of the humeral capitellum. Seventy-two patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up, 57 months; range, 36 to 147 months). The mean patient age was 14.3 years. Clinical outcomes, including elbow range of motion, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated. The mean elbow range of extension/flexion increased significantly, from -21°/122° preoperatively to -4°/136° postoperatively (p < 0.001). The mean clinical rating score improved significantly, from 101 to 190 by the latest follow-up (p < 0.001). The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3. Seventy of the 72 patients returned to their original sport. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results. Costal osteochondral autograft successfully achieved anatomical and biological reconstruction in the treatment of advanced osteochondritis dissecans of the humeral capitellum. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Post-traumatic Malunion of the Distal Radial Intra-articular Fractures Treated With Autologous Costal Osteochondral Grafts and Bioabsorbable Plates

Intra-articular distal radial fractures with partial bone loss at the wrist were reconstructed using osteochondral grafts in 2 patients who were followed up for at least 18 months. Both patients experienced posttraumatic arthrosis of the wrist joint. The materials of the intra-articular fixation were bioabsorbable plates and screws. Reconstruction of a partially destroyed articular surface using a costal osteochondral graft is reliable and allows filling and resurfacing an articular cartilage void.

Costal osteochondral grafting as a treatment method for avascular necrosis of the ring finger metacarpal: a case report

Costal osteochondral grafting as a treatment method for avascular necrosis of the ring finger metacarpal: a case report

Clinical Outcomes of Total Joint Arthroplasty Using Costal Osteochondral Graft for Finger Joint Ankylosis Prospective Evaluation up to 6 Years' Follow-up: Level 4 Evidence

Clinical Outcomes of Total Joint Arthroplasty Using Costal Osteochondral Graft for Finger Joint Ankylosis Prospective Evaluation up to 6 Years' Follow-up: Level 4 Evidence

An experimental study on costal osteochondral graft

To investigate usefulness of osteochondral grafting from the costo-osteochondral junction as a repair technique for articular cartilage defects histologic and biochemical analysis of grafted cartilage in rabbit knees was evaluated up to 48 weeks after transplantation. Twenty New Zealand White rabbits were used. A costal osteochondral plug was harvested from a middle rib. After trimming, it was transplanted into a cylindrical osteochondral 2.5 mm diameter and 5 mm deep defect created in the knee. The animals were sacrificed at 6, 12, 24, and 48 weeks after transplantation. Defect sites were inspected macroscopically, and then by light microscopy. Samples were evaluated for cell viability using a fluorescent in situ double-staining protocol with confocal laser microscopic analysis. Samples were also processed to assess type I & II collagen and aggrecan mRNA expression using reverse transcription-polymerase chain reaction (RT-PCR). Histologically, bone union was achieved in all plugs. Confocal microscopic analysis revealed chondrocyte viability in the 48-week grafts; the distribution of chondrocytes was similar to surrounding articular cartilage. The expression of type II collagen and aggrecan mRNA in the grafted cartilage was consistent with normal articular cartilage and normal costal cartilage. These results were observed over 6-48 weeks. Our study revealed that chondrocytes in the grafted cartilage were viable at least up to 48 weeks and that mRNA expression of type II collagen and aggrecan was also similar to that of normal articular cartilage. These results suggest that costal osteochondral grafting can be a useful alternative in the treatment of osteochondral defects.

Steroid-Induced Osteonecrosis of Bilateral Distal Humerus Treated by Arthroplasty Using Costal Osteochondral Graft: Case Report

We report the case of a 43-year-old man with steroid-induced osteonecrosis of the distal humerus in both arms. Costal osteochondral autografts were used to restore both joints with satisfactory outcomes.

Re: Total joint reconstruction for MP joint ankylosis using costal osteochondral graft: A case report

Re: Total joint reconstruction for MP joint ankylosis using costal osteochondral graft: A case report

Two-stage arthroplasty with joint distraction and costal osteochondral grafting for ankylosis of a metacarpophalangeal joint: Nine years' follow-up

Two-stage arthroplasty with joint distraction and costal osteochondral grafting for ankylosis of a metacarpophalangeal joint: Nine years' follow-up

Finger Joint Reconstruction with Costal Osteochondral Graft

Cartilage disorders of the finger joint may influence hand function. Loss of integrity of the finger joint may severely compromise its stability and may lead to degenerative arthritis. Anatomical reduction of the finger cartilage should be as precise as possible in treating cartilage defects due to trauma and other causes. We have repaired cartilage defects in finger joints by arthroplasty with costal osteochondral grafting in 29 patients (30 joints) since 1997. Three patients underwent total joint reconstruction using costal osteochondral grafting for complete bony ankylosis (1 metacarpophalangeal joint and 2 proximal interphalangeal joints). The purpose of this study was to describe the history, indications, and surgical techniques of the costal osteochondral graft for cartilage disorders or defects in the metacarpophalangeal and proximal interphalangeal joints.

Costal Osteochondral Grafts for Osteochondritis Dissecans of the Capitulum Humeri

The objective of the treatment for osteochondritis dissecans of the humeral capitulum is to prevent the occurrence of osteoarthritis and to allow the patients to return to throwing activities. In repairing osteochondral defects in advanced osteochondritis dissecans of the humeral capitulum after free body removal, we have performed block-shaped costal osteochondral grafting in 18 elbows since 1997. A block-shaped graft harvested from the transitional area between the rib and its associated cartilage was implanted to the osteochondral defect. This method allows the osteochondral defect to be repaired with uniform hyaline cartilaginous articular surface without any effect to other joints. Donor site no longer causes pain at 2 or 3 days after surgery. The purpose of this study is to describe the history, indications, and the surgical techniques of costal osteochondral grafting for advanced osteochondritis dissecans of the capitulum.

Two-stage arthroplasty with joint distraction and costal osteochondral grafting for ankylosis of a metacarpophalangeal joint: Nine years' follow-up

After ankylosis of a finger has occurred, it is often difficult to restore joint mobility. We report a two-stage arthroplasty procedure for correcting ankylosis of the metacarpophalangeal joint, which involved joint distraction to extend the soft tissues, followed by costal osteochondral autografting. After 9 years of follow-up, the results are acceptable.

Arthroplasty of the Interphalangeal Joint of the Great Toe Using Costal Osteochondral Grafting

Although many reports have been published on the usefulness of costal cartilage grafting in the reconstruction of interphalangeal joints of fingers, there are only a few published reports on the reconstruction of interphalangeal joints of toes. We describe a 21-year-old woman with a tissue defect of the dorsum pedis and a partial defect of the interphalangeal joint of the great toe caused by a motor-vehicle accident. We attempted arthroplasty using a free latissimus dorsi myocutaneous flap and a costal osteochondral graft. The grafted rib and cartilage survived, allowing the patient to resume functional ambulation for day-to-day activities. Arthroplasty using costal osteochondral grafts seems to be an effective means of reconstructing the interphalangeal joints of toes.