Preliminary Clinical, Radiographic, and Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienbock Disease.
- 2020
Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
CONCLUSIONS: Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienbock disease, we observed a cessation of radiocarpal collapse. After surgery, patients demonstrated acceptable levels of function, pain, and wrist range of motion. METHODS: Eighteen adult patients underwent medial femoral trochlea reconstruction of the proximal lunate for advanced Kienbock disease by a single surgeon. Eight of these patients returned for clinical examination, radiographs, and completion of PRO questionnaires. An additional 4 patients completed PRO questionnaires remotely. PURPOSE: We aimed to describe the radiographic, functional, and patient-reported outcomes (PROs) of medial femoral trochlea osteochondral free flap reconstruction of the proximal lunate in stage IIIA and IIIB Kienbock disease. RESULTS: The mean patient age was 28.4 years. The mean radiographic and physical examination follow-up was 1.4 and 2.2 years, respectively. The mean PRO follow-up was 2.1 years. Radiographic measurements (carpal height ratio, radioscaphoid angle) demonstrated that carpal collapse was halted, and carpal alignment was maintained, after surgery. Wrist flexion (38.3degree) and extension (37.3degree) were unchanged by this operation, and postoperative pinch and grip strength were 90% and 68% of the uninjured side, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 10.8, and the Patient-Rated Wrist Evaluation score was 18.1. Knee Injury and Osteoarthritis Outcomes Score subscales, International Knee Documentation Committee, and Kujala lower extremity PRO scores ranged from 83.1 to 96.8. The Patient-Reported Outcomes Measurement Information System Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good postoperative patient health and function and low pain levels. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V. Copyright (c) 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.