Perichondrial arthroplasty in the hand: a case report

Perichondrial Arthroplasty Revisited: Technical Pearls

Articular cartilage damage has been a longstanding challenge in hand surgery. Because of its limited ability to heal on its own and its predictable impact on bone resulting in degenerative osteoarthritis, surgical intervention is often mandated, through arthrodesis or implant arthroplasty. In this article, we revisit the perichondrial arthroplasty, a two-stage joint resurfacing technique using autologous rib perichondrium. It is indicated for posttraumatic osteoarthritic changes with or without stiffness and deviation, rheumatoid arthritis, and congenital joint malformation and/or ankylosis. This long-lasting method allows for a functional, pain-free joint that avoids both the immobility of arthrodesis and the long-term complications associated with implants.

Regenerative Potential of Perichondrium: A Tissue Engineering Perspective

The clinical relevance of perichondrium was recognized more than a century ago. In children and adolescents, perichondrium is essential for the formation and growth of the cartilaginous part of craniofacial features and must be considered during reconstructive surgery in the head and neck area. Also in adults, perichondrium must be preserved during surgical intervention for adequate postoperative healing and cartilage maintenance. Furthermore, the regenerative function of perichondrium in the ribs enables the harvesting of the rib cartilage tissue for reconstruction of craniofacial features. With the advancement of tissue engineering, renewed attention has been focused on the perichondrium, because without this crucial tissue, the function of cartilage engineered for craniofacial reconstruction is incomplete and may not be suitable for long-term reconstructive goals. Furthermore, interest in the perichondrium was revived owing to its possible role as a microenvironment containing stem and progenitor cells. Here we will revisit seminal studies on the perichondrium and review the current literature to provide a holistic perspective on the importance of this tissue in the context of regenerative medicine. We will also highlight the functional significance of perichondrium for cartilage tissue engineering.

Chondrocostal grafting for lateral osteochondral injury of the metacarpal head

Osteochondral injuries of the metacarpal head require anatomical restoration to prevent limitations in range of motion and osteoarthritis. Osteochondral bone grafting is a viable option, especially in younger patients. Central injuries allow for different types of grafting, but when the injured area is on the lateral portion of the metacarpal head, the graft must include both a cortical and a cartilaginous portion. We present here the pearls and pitfalls in the surgical technique of chondrocostal grating from the 6th rib and an example of its use within a case of comminuted fracture of the metacarpal head. This technique provides a graft with cortical bone that allows for a stable fixation, with few complications during its harvesting. The graft is viable in the long-term and shows similar magnetic resonance intensities in comparison to hand cartilage.

Osseous ankylosis of the proximal and distal interphalangeal joints of a finger following a snakebite

We present a previously unreported case of osseous ankylosis of both the proximal and distal interphalangeal joints of a finger, as a result of a snakebite.

Intraarticular envenomation by Trimeresurus flavomaculatus mcgregori resulting in joint destruction

This article reports a case of digital intraarticular envenomation from a T. flavomaculatus mcgregori pit viper resulting in severe joint damage. Bites by these snakes are rare in the U.S.A. since this species is only found in collections and zoos. Intraarticular envenomations from crotalids are rare and may result in joint destruction.