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. 2017 Feb;6(1):65-69.
doi: 10.1055/s-0036-1587315. Epub 2016 Aug 5.

Meniscal Allograft Interposition Combined with Proximal Row Carpectomy

Murphy M Steiner  1 , Matthew R Willsey  1 , Frederick W Werner  1 , Brian J Harley  1 , Shay Klein  1 , Kevin J Setter  1
Affiliations

Meniscal Allograft Interposition Combined with Proximal Row Carpectomy

Murphy M Steiner et al. J Wrist Surg. 2017 Feb.

Abstract

Background Proximal row carpectomy (PRC) is contraindicated in wrists with preexisting arthritis of the proximal capitate or radiolunate fossa. Patients with these conditions frequently pursue wrist arthrodesis with its associated functional limitations. Questions/Purposes The purpose of this study was to evaluate the results of using lateral meniscal allograft interposition (LMAI), in combination with PRC, in patients with symptomatic wrist arthritis. The primary question is whether this allograft will allow wrist function comparable to that in patients having only a PRC. A secondary question was to determine the short-term longevity of the allograft. Patients/Method Between 2006 and 2012, nine wrists underwent PRC with LMAI. Patient demographics and rates of complication or graft failure were determined. During independent clinical exams, functional outcomes were reviewed, patients completed a Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and radiographs were taken. Results Four patients met the inclusion criteria, having clinical follow-up at an average of 4.2 years. DASH scores at the time of follow-up ranged from 9 to 33, with an average of 24. Average radiocapitate joint space in the first postoperative radiograph was 2.8 mm compared with 1.8 mm at the time of final follow-up. No wrists went on to arthrodesis. Conclusion Early outcomes of PRC with LMAI are comparable to those results found in the literature of PRC alone. LMAI with PRC may be a valid short-term option as a motion-preserving procedure in those patients contraindicated to having a PRC alone. Level of Evidence Level IV.

Keywords: meniscal allograft; proximal row carpectomy.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Lateral meniscal allograft. Nonabsorbable suture was used to secure the anterior and posterior horns to create custom fit for the distal radius articular surface. (Reprinted with permission from Nanavati et al.3)
Fig. 2
Fig. 2
Illustration of lateral meniscal allograft secured to the distal radius. Four or five absorbable suture anchors were used to secure the periphery of the graft to the articular surface of the distal radius.
Fig. 3
Fig. 3
Postoperative posterior-anterior radiograph immediately following proximal row carpectomy with lateral meniscal allograft interposition. Radiocapitate space represents successful allograft interposition.
Fig. 4
Fig. 4
(A) First follow-up lateral radiograph demonstrating preserved radiocapitate space, representing the lateral meniscal allograft. Lateral radiographs were used to measure changes in radiocapitate space over the follow-up period. (B) Lateral radiograph in the same patient demonstrating partial narrowing of radiocapitate space 5 years following lateral meniscal allograft interposition.
See this image and copyright information in PMC

References

    1. Tomaino M M, Miller R J, Cole I, Burton R I. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg Am. 1994;19(1):134–142. - PubMed
    1. Jebson P J, Hayes E P, Engber W D. Proximal row carpectomy: a minimum 10-year follow-up study. J Hand Surg Am. 2003;28(4):561–569. - PubMed
    1. Nanavati V N, Werner F W, Sutton L G, Klena J. Proximal row carpectomy: role of a radiocarpal interposition lateral meniscal allograft. J Hand Surg Am. 2009;34(2):251–257. - PubMed
    1. Creighton R A, Cole B J, Nicholson G P, Romeo A A, Lorenz E P. Effect of lateral meniscus allograft on shoulder articular contact areas and pressures. J Shoulder Elbow Surg. 2007;16(3):367–372. - PubMed
    1. Ball C M, Galatz L M, Yamaguchi Ken. Meniscal allograft interposition arthroplasty for the arthritic shoulder: Description of a new surgical technique. Techniques in Shoulder & Elbow Surgery. 2001;2(4):247–254.