Metacarpophalangeal Joint Reconstruction Using a Vascularized Cartilage and Bone Graft

The metacarpophalangeal joint is vital for hand function. Cartilage loss of the joint is central to the development of joint failure in arthritis. Although various treatments have been proposed, the management remains a challenging problem.Previous anatomical studies have shown that, at the base of the metacarpal, there were nutrient arteries inserting into the dorsum of the metacarpal. The nutrient arteries arise from the distal and middle dorsal carpal arches that run distally to the first to fourth dorsal metacarpal arteries (DMAs. These studies prompt us to use a reverse vascularized cartilage and bone graft based on the DMA. The metacarpal consists of a widened proximal base. The joint surface to the capitate is convex anteriorly and dorsally concave, where it extends to the styloid process on the dorsolateral aspect of the metacarpal base. The unique contour stimulates our imagination and creativity to use a portion of the joint surface for reconstruction of metacarpophalangeal joint defects. The purpose of this study is to report the novel technique and to evaluate the effectiveness of the treatment.

Inclusion criteria

• a cartilage defect at either proximal or distal MCP joint;
• either an acute or old injury;
• loss of 1/4 of joint entire surface that seen on plain radiographs, CT scan, and intraoperative finding;
• and with or without MCP joint subluxation.

Exclusion criteria

• large defects involved double joint surfaces;
• the size of the defect involving less than 1/4 of the joint surface;
• associate with infection or other diseases that restrict to use the technique.