Avascular Necrosis of the Metacarpal Head in Skeletally Immature Patients Treated with Osteochondral Autograft Transfer System

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 fi nger 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)

Key words: avascular necrosis of metacarpal head, osteochondral autograft