Long-Term Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction

Abstract

Purpose

The long-term outcomes of the medial femoral trochlea (MFT) osteochondral free flap for proximal pole scaphoid nonunion (SNU) reconstruction are unknown. The primary purpose of this study was to evaluate the upper and lower extremity patient-reported outcomes (PROs) of MFT for SNU reconstruction at a follow-up of >9 years.

Methods

Patients who underwent MFT for SNU reconstruction by the senior author >9 years ago were contacted to complete PRO questionnaires. Upper-extremity outcomes were reported with the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE). Knee outcomes were reported with the International Knee Documentation scale, Knee Injury and Osteoarthritis Outcome Score, Kujala Anterior Knee Pain scale, and Western Ontario and McMaster Universities Osteoarthritis Index scales; scores were compared with normative data or established patient-acceptable symptom state thresholds to provide context. Long-term radiographic evaluation of scapholunate and radiolunate angles and revised carpal height ratio was also performed.

Results

Eleven of 12 patients completed PROs. The mean follow-up time was 10.2 years (range: 9.2–11.7). Bony union was achieved in all cases. The mean long-term QuickDASH was 4.5 ± 5.8, PRWE total 7.8 ± 9.1, and PROMIS UE 55.8 ± 6.1—all similar to normative population scores. The mean International Knee Documentation score was 91.2 ± 15.9 and Western Ontario and McMaster Universities Osteoarthritis Index score 96.0 ± 11.2; both comparable with normative data. The Kujala and Knee Injury and Osteoarthritis Outcome Scores reflected good postoperative knee function and minimal pain. None demonstrated radiographic evidence of radioscaphoid arthritis. There was no difference between preoperative and postoperative average scapholunate or radiolunate angle. Postoperative revised carpal height ratio (1.6) was similar to preoperative (1.5).

Conclusions

Medial femoral trochlea reconstruction for difficult, recalcitrant scaphoid proximal pole nonunion provides satisfactory, sustained long-term upper-extremity outcomes and stable radiographs with minimal donor-site morbidity.

Type of study/level of evidence

Therapeutic IV.