Treatment of Medial Patellar Instability With Bipolar Patellofemoral Cartilage Lesions: Staged De-rotational Distal Femoral Osteotomy Followed by Bipolar Osteochondral Allograft Transplantation and Tibial-Tubercle Osteotomy.

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Abstract

Conflict of interest statement: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. 18. J Surg Orthop Adv. 2025 Summer;34(2):69-72. Avascular Necrosis of the Metacarpal Head in Skeletally Immature Patients Treated with Osteochondral Autograft Transfer System. Brown CC(1), Cohen-Brown J(2), Li Z(3). Author information: (1)Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Sansum-Santa Barbara Medical Clinic, Santa Barbara, California. (2)Sansum-Santa Barbara Medical Clinic, Santa Barbara, California. (3)Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Avascular necrosis of the metacarpal head, or Dietrich's disease, is a rare entity with approximately 40 reported cases in the literature since the original description. No consensus exists on optimal treatment. The purpose of this case series is to report the presentation and outcome of avascular necrosis (AVN) of the metacarpal head in skeletally immature patients treated with osteochondral autograft system. The authors prospectively assessed two male skeletally immature patients and three metacarpal heads who underwent osteochondral autograft transfer systems (OATS) from the ipsilateral knee for avascular necrosis of metacarpal heads after failure of conservative treatment. Outcome measures included patient-reported pain, metacarpophalangeal joint (MPJ) range of motion (ROM) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Two years after surgery, both patients returned to sporting activities with pain-free finger motion. Mean MPJ ROM improved from a range of 0 - 60 degrees to a range of 5 degrees of hyperextension to 75 degrees of flexion postoperatively. Mean DASH score improved from 27 preoperatively to 1.25 postoperatively. Radiographs revealed consolidation of osteochondral graft without signs of arthritis. OATS is a viable treatment option for young, high-demand patients presenting with avascular necrosis of the metacarpal head. (Journal of Surgical Orthopaedic Advances 34(2):069-072, 2025).