Lunate Reconstruction Using Osteochondral Vascularized Graft in Kienböck’s Disease

Abstract

There is a general consensus that the pathogenesis for Kienböck’s disease remains uncertain, though it is probably related to nonphysiologic stress transmission across the lunate, acting in concert with one of several possible vascular abnormalities. Most surgical treatments focus on mechanical aspects rather than real physiopathology, but in the recent years several articles have shown the utility of vascularized grafts in the treatment of Kienböck’s disease, especially in its early stages. The authors present a case of a successfully reconstruction of a IIIA stage Kienböck’s disease with an osteochondral vascularized graft from medial femoral condyle.

Keywords

Kienböck’s disease - lunate morphology - medial femoral condyle - osteochondral vascularized graft - microsurgery

• References

• 1 Lichtman DM, Pientka II WF, Bain GI. Kienböck disease: moving forward. J Hand Surg Am 2016; 41 (05) 630-638
• 2 Stahl S, Stahl AS, Meisner C. et al. Critical analysis of causality between negative ulnar variance and Kienböck disease. Plast Reconstr Surg 2013; 132 (04) 899-909
• 3 Lutsky K, Beredjiklian PK. Kienböck disease. J Hand Surg Am 2012; 37 (09) 1942-1952
• 4 Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteochondral flap reconstruction of advanced Kienböck disease. J Hand Surg Am 2014; 39 (07) 1313-1322
• 5 Higgins JP, Bürger HK. Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications. J Reconstr Microsurg 2014; 30 (07) 483-490
• 6 Pichler M, Putz R. The venous drainage of the lunate bone. Surg Radiol Anat 2003; 24 (06) 372-376
• 7 Beredjiklian PK. Kienböck’s disease. J Hand Surg Am 2009; 34 (01) 167-175
• 8 del Piñal F, Klausmeyer M, Moraleda E. et al. Vascularized graft from the metatarsal base for reconstructing major osteochondral distal radius defects. J Hand Surg Am 2013; 38 (10) 1883-1895
• 9 Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery 1994; 15 (05) 305-315
• 10 Choudry UH, Bakri K, Moran SL, Karacor Z, Shin AY. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg 2008; 60 (02) 174-180
• 11 Cavadas PC, Landín L. Treatment of recalcitrant distal tibial nonunion using the descending genicular corticoperiosteal free flap. J Trauma 2008; 64 (01) 144-150
• 12 Higgins JP, Burger HK. Proximal scaphoid arthroplasty using the medial femoral trochlea flap. J Wrist Surg 2013; 2 (03) 228-233
• 13 Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienböck’s disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am 1977; 59 (07) 899-908
• 14 Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienböck’s disease. Hand Clin 1993; 9 (03) 409-416
• 15 Schmitt R, Kalb K. Bildgebende Diagnostik der Lunatumnekrose. Handchir Mikrochir Plast Chir 2010; 42 (03) 162-170
• 16 Bain GI, Durrant A. An articular-based approach to Kienbock avascular necrosis of the lunate. Tech Hand Up Extrem Surg 2011; 15 (01) 41-47
• 17 Windhofer C, Wong VW, Larcher L, Paryavi E, Bürger HK, Higgins JP. Knee donor site morbidity following harvest of medial femoral trochlea osteochondral flaps for carpal reconstruction. J Hand Surg Am 2016; 41 (05) 610-614