Osteochondral Autograft Transplantation to the Metacarpal Head for Avascular Necrosis in a Young Active Patient: Case Report and Technique Overview

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Abstract

Background:

Aseptic avascular necrosis of the metacarpal head, or Dieterich disease, is a rare and painful condition of unknown etiology. There is no consensus regarding optimal treatment, although multiple surgical options have been described. Many cases are refractory to nonoperative management.

Materials and Methods:

We present a case of a young, active patient with avascular necrosis of the long finger metacarpal head that was treated surgically with osteochondral autograft transplantation. An osteochondral autograft system was used to remove a 10×13 mm core, which contained the entire osteochondral defect. An incision was made and the superior lateral aspect of the trochlea was exposed through a small fascial incision. A size-matched core was harvested from the lateral aspect of the trochlea proximal to the sulcus terminalis in the non–weight-bearing portion of the lateral condyle. The harvested osteochondral donor fragment was then transplanted into the defect in the metacarpal head and noted to be an excellent size match.

Results:

At 2 weeks postoperative, the patient had nearly full range of motion of both the affected hand and the donor knee. Radiographs demonstrated a small intra-articular step-off of <1 mm, which was appreciated in the intraoperative fluoroscopic image and is within the acceptable limits for metacarpophalangeal joint step-off. At one year postoperative he was pain-free with a QuickDASH score of 2.3.

Conclusions:

Avascular necrosis of the metacarpal head in a young patient can be a challenging problem, especially when it is resistant to conservative therapy. Arthroplasty or arthrodesis could be reliable options in older, lower-demand patients, but are not appropriate for a young, high-demand patient.

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