The free vascularized lateral femoral trochlea osteochondral graft: a reliable alternative for Stage III Kienböck’s disease

Abstract

Lunate reconstruction using a lateral femoral trochlea osteochondral graft was carried out in 27 patients with Stage III Kienböck’s disease from 2012 to 2019. Twenty-three of these patients could be followed-up in this retrospective study. Ten were women and 13 men. Nine were Lichtman Stage IIIA, seven Stage IIIB and seven Stage IIIC. The mean follow-up was 39 months (range 12–86). Bony consolidation was found in 18 of the 23 patients, with no graft loss. The mean Disabilities of the Arm, Shoulder and Hand score (DASH score) was 11 and the Modified Mayo Wrist Score was 83. There were only two radiological deteriorations, with the same or improved Lichtman classifications in the other patients and a significant reduction in pain. Postoperative extension of the wrist (52°) and flexion (48°) were comparable with preoperative values and, respectively, 81% and 72% of the contralateral side. Grip strength and pinch grip were 32 kg and 12 kg, 88% and 94% of the other hand, respectively, and an insignificant increase compared with the preoperative values. The vascularized lateral femoral trochlea osteochondral graft yields good short- and mid-term results in Grade III Kienböck’s disease. Level of evidence: IV

Metacarpophalangeal Joint Reconstruction of a Complex Hand Injury with a Vascularized Lateral Femoral Condyle Flap Using an Individualized 3D Printed Model—A Case Report

“…Therefore, these flaps provide various configurations of vascularized bone with nominal donor site morbidity [10,12]. Fundamentally, vascularized flaps from the femoral condyles are primarily utilized in the reconstruction of carpal disorders, in particular scaphoid and lunate, yielding proven outcomes [11,[13][14][15][16]. Additionally, case reports of successful reconstruction of the ulna [17,18], radius [17,19], clavicle [20][21][22], and talus [23,24] using femoral condyle flaps can be found in the current literature.…”

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

“…The LFT receives arterial supply via the SLGA 88 and can be used in cases where trauma precludes the use of an MFT flap or based on surgeon preference. Windhofer et al 89 used the LFT to for lunate reconstruction in patients with Grade III Kienböck's disease and found most patients to be satisfied with their results. The authors suggest that the LFT is amenable to the curved shape of the lunate fossa.…”

“…Donor-site morbidity included knee pain. 89 Future studies are necessary due to limited experience with LFT flaps for UE reconstruction.…”

Komplizierter Verlauf einer juvenilen Lunatumnekrose

“…Eine revaskularisierende Therapie im Sinne einer Mondbeinrekonstruktion wird für die Lunatumnekrose der Gruppe IIIC nach Lichtman als nicht unproblematisch gesehen. So gehörten in einer rezenten Studie 4 der 5 Patienten, in welchen es zu keiner Heilung des vaskularisierten osteochondralen lateralen Femurspans gekommen ist, der Gruppe der Lunatumnekrose IIIC an [7]. In Algorithmen werden für diese Patienten meist ein Lunatumersatz, eine Entfernung der proximalen Handwurzelreihe oder Teilfusionen empfohlen [8].…”