Name: Use of BioCartilage® Allograft to Repair Focal Chondral Defects of the 1st MTP Joint
Uploaded: 2020-06-05T00:00:00Z
Channel: Arthrex
Description: Joseph N. Hall, DPM (Mill Creek, WA), presents his preferred technique of using a BioCartilage ® allograft when treating symptomatic cartilage lesions in the 1st MTP joint.

<p>Joseph N. Hall, DPM (Mill Creek, WA), presents his preferred technique of using a BioCartilage<sup>®</sup> allograft when treating symptomatic cartilage lesions in the 1st MTP joint.</p>

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VID1-000916-en-US | A | Use of BioCartilage® Allograft to Repair Focal Chondral Defects of the 1st MTP Joint

Joseph N. Hall

Human

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Cirujanos que presentan uno o más casos clínicos.

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Use of BioCartilage® Allograft to Repair Focal Chondral Defects of the 1st MTP Joint

I'm Doctor Joe Hall from Mill Creek, Washington, in the Seattle area. Let's start with a case presentation. This is a 49 year old male who's an avid soccer player, who has been having troubles in his first metatarsophalangeal joint for the past year, but recently jammed his big toe joint a month prior to seeing me. Upon physical exam, he had pain in the dorsal first metatarsophalangeal joint with range of motion and palpation. He had a crepitus with range of motion. On radiographs, he had a joint space narrowing on the first metatarsophalangeal joint centrally and then laterally. On this first, on his first metatarsal head you can see like an impaction injury, where he has what's highly suspicious for an osteochondral defect on a lateral view, he had a cavus foot type with a dorsal exostosis at the first metatarsal head, as well as the base of the proximal phalanx. So we discussed his treatment options being this is kind of a newer injury. We discussed, you know, maybe letting calm down and being in a cam walker for four weeks. So we talked about doing a cortisone injection. However I don't like to do cortisone within the joint Because I think that will actually just degrade the joint more. We talked about doing a platelet rich plasma injection and also getting them in a stiff soled shoe to eliminate range of motion in the joint and orthotic to help stabilize his first metatarsal. But in my opinion, this was really a surgical case. And so in the past, I would have probably done a collecti with a microfracture of the lesion. But like I said, I just haven't had really good results with that over over the years. And so I wanted to do something a little more definitive for him. So another option would have been the first metatarsophalangeal joint arthrodesis or an implant. But being an avid soccer player, he wants to continue to play soccer. I didn't feel like these are really good options for him. So we decided to do a colectomy with BioCartilage and the platelet rich plasma. So when it got into the wound, this is what we found. There was a defect at the central lateral portion of the first metatarsal head. A large defect in the past which I may have microfracture, but we decided here we would use a BioCartilage. And so what I like to do when we use BioCartilage is I like to create good vertical edges. And so I'll take a 15 blade and create a nice vertical edge to allow stability to the BioCartilage. Once it's placed into the defect, I'll use a mini curette to take out any fibrous tissue within the defect. And then typically then we'll do my your typical 0.045 microfracture holes. Once I decide that I'm going to do BioCartilage we, then I will have the anesthesiologist then go and draw blood from the arm and take this venous blood, and we'll spin it down and separate the whole blood from the platelet rich plasma that is then placed on the back table with the scrub tech. And the scrub tech will start preparing the BioCartilage with the platelet rich plasma. Arthrex has a mixing syringe that we typically will use. What I like to do is mix this to where it's like a fine putty, and so it's not too aqueous. So I like to start with like 0.5 cc's into the mixing syringe and then place the BioCartilage and then put another 0.5 cc's of the platelet rich plasma in there. I have the scrub techs mix it up and set it aside for implantation. Station. It has a cannula. As you can see in number six here, that you can use when you're using this arthroscopically. But typically with an open joint like this, in the first metatarsophalangeal joint, I'll just use my freer and kind of spackle it into the defect. And I want this to be consistent with the surrounding cartilage, and I don't want it too proud. I want to make sure that it's flush with the surrounding cartilage, because otherwise, when they start the range of motion, most likely this is going to shear off. And so sometimes we have to take these defects and kind of deal them out a little bit. You'll find times where the cartilage just doesn't look. It's just thinned out cartilage. And it doesn't look as deep as it should be. So I'll take a rotary bur like a two millimeter rotary bur and kind of deal out the the defect. So I have space to put the BioCartilage in so it's flush and not proud with the remaining cartilage. One of the troubles with this is when you do a microfracture you're promoting bleeding into the defect which if it bleeds too much, which some people just kind of ooze, as you know, then then it's tough to get this to kind of set into place. So I'd like to control the bleeding as much as possible. And so there's a couple techniques I'll use. Typically I'll use an ankle cuff or a thigh cuff after drilling the defect to minimize the bleeding. I'll use bone wax at the raw bone surfaces, especially if I'm doing a colectomy to help prevent any drippage into the into the lesion. And then we'll use a sealant to kind of set the BioCartilage into the defect. Typically I'll use what's called to seal, which is a fibrin glue. Lately I've been using autologous thrombin. This, I've found, helps coagulate a little bit better and also helps kind of set into set the BioCartilage into the defect a little bit better. This is done with whole blood and the platelet poor plasma mixture to create a fibrin clot. Once the the clot is formed and the glue is dried, we then will do a light flush to kind of help remove any remaining glue in the area. And then we'll go through our typical closure.

Use of BioCartilage® Allograft to Repair Focal Chondral Defects of the 1st MTP Joint

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