Vascularized medial femoral trochlea osteochondral flap reconstruction of advanced Kienbock disease.

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Citation: J Hand Surg [Am]. 39(7):1313-22, 2014 Jul.Journal of Hand Surgery - American Volume. 39(7):1313-22, 2014 Jul.PMID: 24855965Institution: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter StudySubject headings: *Bone Transplantation/mt [Methods] | *Lunate Bone/su [Surgery] | *Osteonecrosis/su [Surgery] | *Reconstructive Surgical Procedures/mt [Methods] | *Surgical Flaps/bs [Blood Supply] | Adult | Arthroplasty/mt [Methods] | Cartilage/su [Surgery] | Cartilage/tr [Transplantation] | Cohort Studies | Female | Femur/su [Surgery] | Follow-Up Studies | Graft Rejection | Graft Survival | Humans | Lunate Bone/pp [Physiopathology] | Lunate Bone/ra [Radiography] | Male | Middle Aged | Osteonecrosis/ra [Radiography] | Retrospective Studies | Risk Assessment | Severity of Illness Index | Surgical Flaps/tr [Transplantation] | Treatment Outcome | Young AdultYear: 2014Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:
  • 0363-5023
Name of journal: The Journal of hand surgeryAbstract: 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.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 osteotomies, 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.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.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 50degree extension and 38degree flexion, similar to preoperative measurements. Grip strength at follow-up was 85% of the contralateral side.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.All authors: Burger HK, Gaggl AJ, Higgins JP, Windhofer CFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-07-15
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 24855965 Available 24855965

Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present

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.

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 osteotomies, 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.

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.

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 50degree extension and 38degree flexion, similar to preoperative measurements. Grip strength at follow-up was 85% of the contralateral side.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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