ASCOT- Autologous use of bone marrow derived Stem Cells for Osteoarthritis of the Thumb-1st CMCJ
Matthew P. Murphy, MB BCh BAO MRCSI, Emma Carr, BSc, Conor Sugrue, MB BCh MRCSI, Christina Buckley, MB BCh BAO MRCSI, Shane O'Neill, MBBS ASPS FRACS, Sean Carroll, MB BCh MD FRCSI (Plast).
St. Vincents University Hospital, Dublin 4, Dublin 4, Ireland.
Purpose: The 1st Carpometacarpal Joint (CMCJ) in the hand is a commonly affected joint by Osteoarthritis (OA). It causes significant thumb base pain, limiting functional capacity. Surgical techniques are fraught with complications. Conservative management slows disease progression but does not reverse pre-existing damage. Microfracturing and application of Autologous Stem Cells has been performed on large joints such as the knee but has never been evaluated for use in the smaller joints in the hand. Our aim is to determine the potential benefit of Autologous Bone Marrow Stem Cells (BMSC) for treatment of osteoarthritis of the 1st CMCJ in the hand.
Methods: All inclusion criteria were satisfied and patients were consented. Pre-operative assessment by the surgeon, Physiotherapist (PT) and Occupational Therapist (OT) was performed. Intra-operatively, BMSC were isolated from the hip via BMAC. The 1st CMCJ was opened and the joint surface microfractured. The BMSC were applied directly to the microfractured articular surface. Post-operatively the patients were followed up at regular intervals by the same surgeon, PT and OT. The assessments performed included: the visual analogue score (VAS) at rest and with activity, range of motion (ROM) in palmar abduction, functional DASH, strength test by lateral pinch, kapandji opposition score and the Grind Test. Statistical analysis was done using Prism Software, comparing preoperative scores and scores 6 months later using a paired T-test.
Results: All patients had a positive Grind test preoperatively and a negative test after 6 months. Statistically significant improvements were seen (Means scores with P values) VAS at rest 3.25 to 1.425 (P=0.0138), VAS on activity 7.7 to 3.9 (P=0.0021), ROM 46o to 53o (P= 0.0095) and DASH 47.23 to 18.7 (P=0.0046). Strength and Kapandji score improved insignificantly at 6 months. There were no significant postoperative complications. Patients were satisfied with the procedure.
Conclusions: This innovative pilot study is a new approach to OA of the thumb. It is a safe procedure with no post op complications. ASCOT 2 will be designed to determine the exact role of BMSC in this procedure with a control group receiving microfracture alone.
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