Clinical, Radiographic, and Patient Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienbock's Disease
Mitchell A Pet, MD1; Patrick E Assi, MD1; Aviram M Giladi, MD, MS2; James P Higgins, MD2
1Medstar Union Memorial Hospital, Baltimore, MD, 2The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
Purpose:
We aim to describe the mid-term radiographic, functional, and patient-reported outcomes of medial femoral trochlea (MFT) osteocartilaginous free flap reconstruction of the proximal lunate in stage IIIA and IIIB KienbockÕs disease.
Methods:
18 adult patients who underwent MFT reconstruction of the proximal lunate for advanced KienbocksÕ disease by a single surgeon were eligible for this study. Those who could be contacted were asked to return for clinical examination, radiographs, and completion of patient reported outcomes (PRO) questionnaires.
Results:
Mean patient age was 28.4 years. Radiographic and physical examination follow-up were 1.4 and 2.2 years respectively. 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 (38.3¡) and extension (37.3¡) were not significantly changed by this operation, and post-operative pinch and grip strength were 88% and 70% of the uninjured side, respectively. Mean post-operative Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.8, and Patient Rated Wrist Evaluation (PRWE) score was 18.1. In patients with both pre-and post-operative scores available, DASH significantly improved by 23.4 points.
Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, International Knee Documentation Committee (IKDC), and Kujala lower extremity PRO scores ranged from 83.1 to 96.8 and are detailed in Table 1. PROMIS Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good post-operative patient health and function, and low pain levels (Table 1).
Increased age at the time of surgery was found to be significantly predictive of superior lower extremity and global patient reported outcomes. BMI, gender, disease stage, presence of a coronal plane lunate fracture, dominance of the injured side, and prior radial shortening osteotomy were not found to predict patient reported outcomes
Conclusions:
MFT reconstruction of proximal lunate in advanced KienbockÕs disease has the potential to halt radiocarpal collapse, improve function, and relieve pain without causing wrist stiffness, weakness, or excessive donor site morbidity. This study of clinical, radiographic, and patient reported outcomes represents longer and more comprehensive follow-up than our previous reports on this growing patient cohort.
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