Purpose
To describe the radiographic, functional, and patient-reported outcomes (PROs) of
medial femoral trochlea (MFT) osteochondral free flap reconstruction of the proximal
scaphoid at approximately 2 years follow-up.
Methods
Eleven patients who underwent MFT reconstruction of the proximal scaphoid returned
for clinical examination, radiographs, and completion of PROs questionnaires. For
another 10 patients who were unable to return, data were gathered remotely or from
the medical record.
Results
Mean radiographic follow-up was 2.0 years and mean examination follow-up ranged from
2.6 to 2.8 years. Mean follow-up for several PROs ranged from 2.8 to 2.9 years. On
average, carpal collapse did not progress, and radiolunate angle was significantly
improved by 9.5°. Wrist flexion (41.6°; –6%) and extension (43.8°; –7%) were only
slightly changed, and dominance-corrected postoperative pinch and grip strength were
77% and 72% of the uninjured side, respectively. Mean postoperative Disabilities of
the Arm, Shoulder, and Hand (DASH) score was 10.7. In patients with both pre- and
postoperative scores available, DASH significantly improved by 15 points. Knee donor-site
morbidity was measured on the Knee Injury and Osteoarthritis Outcome Score (KOOS)—Sports
and Recreation and the Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC) scales. The Patient-Reported Outcomes Measurement Information System (PROMIS)
Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior
scores reflected good postoperative patient health and function and low pain levels.
Higher body mass index (BMI) was found to be predictive of inferior lower extremity
and global PROs.
Conclusions
An MFT reconstruction of proximal scaphoid nonunion has the potential to restore normal
functional radiocarpal anatomy, improve function, and relieve pain without causing
wrist stiffness or weakness. Donor-site morbidity has been further delineated in this
study. Caution is warranted when considering this procedure in patients with elevated
BMI because they may be at increased risk for donor-site morbidity.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: October 17, 2019
Accepted:
August 6,
2019
Received:
November 14,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
