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Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study
Carol Lee1, Steven Shin1, Genevieve Fraipont2
1Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Purpose:
The purpose of this study was to evaluate whether addition of dermal allograft augmentation after proximal row carpectomy (PRC) restores the contact characteristics of the radiocarpal joint to more closely resemble those of an intact radiocarpal joint.
Methods:
Eight cadaveric wrists were mounted on a testing system that allowed for loading of the wrist tendons. A pressure sensor was inserted into the radiocarpal joint in the pre-PRC wrist, post-PRC wrist, and post-PRC with dermal allograft augmentation, both as a single layer (SL) and double layer (DL). Contact area, contact pressure, and peak pressure at 13 static positions of radial-ulnar deviation and flexion-extension were collected.
Results:
Proximal row carpectomy decreased contact area compared with the intact state at 10° and 30° of flexion and 10°, 20°, and 30° of extension. Proximal row carpectomy augmented with SL dermal allograft had a higher contact area than PRC alone at all positions except 10° of radial deviation and 20° and 30° of flexion. Proximal row carpectomy with DL allograft had a higher contact area compared with PRC alone at all positions except 10° of radial deviation. Proximal row carpectomy alone had higher contact pressure than the intact wrist across all positions except for 10° of radial deviation. Proximal row carpectomy with SL augmentation decreased the contact pressure at 10°, 20°, and 30° of extension. Proximal row carpectomy with DL augmentation restored contact pressure to intact in all positions except for 10° of radial deviation.
Conclusions:
Dermal allograft augmentation following PRC increased the contact area and decreased the contact pressures and peak pressures within the joint, with DL allograft more closely restoring biomechanical properties of the intact joint.
Clinical Relevance:
In demonstrating that dermal allograft augmentation after PRC reduces contact pressures and more closely restores joint mechanics to the intact wrist, these findings illustrate the potential beneficial role of dermal allograft interposition and warrant further clinical investigation.
