Metacarpophalangeal Joint Reconstruction Using a Vascularized Cartilage and Bone Graft

Overview

Traumatic cartilage loss of the joint is central to the development of joint failure in arthritis. The study on the use of a bone graft for reconstruction of metacarpophalangeal joint defects.

Full Title of Study: “Phase 1 Study for Reconstruction of Metacarpophalangeal Joint Using a Vascularized Cartilage and Bone Graft From the Third Metacarpal”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Participant)
  • Study Primary Completion Date: January 2005

Detailed Description

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.

Interventions

  • Procedure: MCP joint
    • reconstruction of metacarpophalangeal (MCP) joint using a bone graft

Arms, Groups and Cohorts

  • Experimental: MCP joint
    • reconstruction of metacarpophalangeal (MCP) joint

Clinical Trial Outcome Measures

Primary Measures

  • Range of motion; Arm, Shoulder and Hand questionnaire
    • Time Frame: 4 years
    • The active motions of the hand were measured by a goniometer. The patients rated their MCP joint pain, the donor joint pain, and scar pain using a line by a visual analogue scale (VAS). We used the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to assess the hand function.

Secondary Measures

  • Pain
    • Time Frame: 4 years
    • joint pain is assessed using visual analogue scale

Participating in This Clinical Trial

Inclusion Criteria

1. a cartilage defect at either proximal or distal MCP joint; 2. either an acute or old injury; 3. loss of 1/4 of joint entire surface that seen on plain radiographs, CT scan, and intraoperative finding; 4. and with or without MCP joint subluxation. Exclusion Criteria:

1. large defects involved double joint surfaces; 2. the size of the defect involving less than 1/4 of the joint surface; 3. associate with infection or other diseases that restrict to use the technique.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • The Second Hospital of Qinhuangdao
  • Provider of Information About this Clinical Study
    • Principal Investigator: Xu Zhang, Director – The Second Hospital of Qinhuangdao
  • Overall Official(s)
    • Xu Zhang, MD, Study Chair, The Second Hospital of Qinhuangdao

Citations Reporting on Results

Sebastin SJ, Mendoza RT, Chong AKS, Peng YP, Ono S, Chung KC, Lim AYT. Application of the dorsal metacarpal artery perforator flap for resurfacing soft-tissue defects proximal to the fingertip. Plast Reconstr Surg. 2011 Sep;128(3):166e-178e. doi: 10.1097/PRS.0b013e318221ddfa.

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