Vascularized Medial Femoral Trochlea Osteochondral Flap Reconstruction of Advanced Kienbock Disease

Purpose To describe the operative technique and report the results of 16 consecutive cases of arthroplasty for advanced Kienbock disease using a vascularized osteochondral graft from the medial femoral trochlea (MFT) with a minimum 12-month follow-up. Methods Chart reviews of 16 cases of osteochondral MFT flap transfers for lunate reconstruction were performed in 2 institutions. Mean patient age was 35 years (range, 19-51 y). Preoperative Lichtman staging was 2 in 7 patients, 3a in 8 patients, and 3b in 1. Five of 16 patients had undergone a previous procedure for Kienbock disease (3 radial shortening osteotornies, 1 wrist denervation, and 1 distal radius vascularized bone grafting). Ulnar variance recorded at the time of the MFT reconstruction was negative in 8 patients, positive in 6 patients, and neutral in 2 patients. Follow-up data were recorded at a minimum of 12 months (average, 19 mo). Radiographic parameters recorded included preoperative ulnar variance, preoperative and final follow-up radioscaphoid angle, lunate height, lunate diameter, and the Stahl index and Lichtman stage. Results Healing was confirmed in 15 of 16 reconstructed lunates. Lichtman staging remained unchanged in 10 patients, improved in 4 patients from grade 3a and 3b to 2, and worsened in 2 patients from grade 3a to 3b. All but 1 patient experienced improvement in wrist pain (12/16 complete relief; 3/16 incomplete relief). Wrist motion at follow-up averaged 500 extension and 38 flexion, similar to preoperative measurements. Grip strength at follow-up was 85% of the contralateral side. Conclusions Osteochondral vascularized MFT flaps provided a reliable means of lunate reconstruction in advanced Kienbock disease. This flap allowed resection of the proximal portion of the collapsed lunate and reconstruction with an anatomically analogous convex segment of vascularized cartilage-bearing bone. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.