chondral transplant of the great toe

[notuno]

Hello,
I am a 41 year old man and 15 months ago I injured by big toe.  I have been diagnosed (after three X-ray, two MRI scans, and one technnetium scan) a chondral lesion at the metatarsal / phalanx joint.
This has been treated with ultrasound, condroitin sulphate pills for three months, anti-inflammatory drugs on and off, and an insole. The pain when I walk is still there and at times intense. I have two questions:

1. Several physicians have propose hyaluronic acid or cortisone injections. Which is recommended?

2. One physician offered to perform a chondral transplant, consisting in taking fresh chartilage from my knee and implanting it in the toe, with arthroscopic surgery.  Would you recommend it? What is the likelihood
of success and the possible complications?

I understand this is a fairly untested procedure for the toe, I have searched the medical literature and I have found very little, for instance:
http://www.ncbi.nlm.nih.gov/pubmed/17144968
http://www.sciencedirect.com/science/article/pii/S0891842211000061

Thank you.

[notuno]

Hi and thanks for your reply. Concerning the transplant, after seeing the orthopedician that recommended the transplant, I saw three other orthopedicians and they all discouraged me from pursuing it.
However I must say none of them was familiar with this procedure for the toe. Apparently the first orthopedician said he has performed several such transplants and is very well respected.

[S. Kaul, MD]

Hi there!

1. Well I would prefer hyaluronic acid over cortisone, but it is possible that both may be required in your case, depending on the inflammatory process. This is a decision to be taken on individual basis. You could discuss it with your orthopedician.
2. Chondral transplant may be a treatment for cartilage defects but I would usually like to reserve it for severe cases where other options have failed; besides one wouldn’t want to disturb the knee joint unless absolutely required.

In short, without the relevant clinical details, I may not be the best person to answer your questions. Yes, these are potential treatment options, but I am not sure if they are best suited in you case. I would suggest seeking a second opinion with another orthopedician.

Hope this was useful.

Take care!