Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results

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

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Medial Femoral Trochlea Osteochondral Graft: A Quantitative Anatomic Comparison to the Proximal Pole of the Scaphoid

Journal of Wrist Surgery ◽

10.1055/s-0040-1708862 ◽

2020 ◽

Vol 09 (04) ◽

pp. 283-288

Author(s):

J. Ryan Hill ◽

Nathanael Heckmann ◽

Braden McKnight ◽

Eric A. White ◽

Alidad Ghiassi ◽

...

Keyword(s):

Articular Surface ◽

Three Dimensional ◽

Critical Factor ◽

Rank Test ◽

Radius Of Curvature ◽

Osteochondral Graft ◽

Proximal Pole ◽

Femoral Trochlea ◽

Articular Surfaces ◽

Three Dimensional Models

Abstract Background Treatment of scaphoid proximal pole (SPP) nonunion with a vascularized osteochondral graft from the medial femoral trochlea (MFT) has been described, with positive outcomes thus far. However, our understanding of the congruency between the articular surfaces of these structures is incomplete. Objective Our purpose was to evaluate the congruency of the MFT and SPP using a quantitative anatomical approach. Methods The distal femur and ipsilateral scaphoid were dissected from 12 cadavers and scanned with computerized tomography. Three-dimensional models were created and articular surfaces were digitally “dissected.” The radius of curvature (RoC) of the radioulnar (RU) and proximodistal (PD) axes of the SPP and MFT, respectively, as well as the orthogonal axes (SPP, anteroposterior [AP]; MFT, mediolateral [ML]) were calculated. The RoC values were compared using the Wilcoxon signed-rank test. Results The RoC values for the SPP and MFT were not significantly different in the RU–PD plane (p = 0.064). However, RoC values for the SPP and MFT were significantly different in the AP-ML plane (p = 0.001). Conclusions For most individuals, the RU curvature of the SPP was similar to the PD curvature of the MFT. For nearly all individuals, the AP curvature of the SPP and the ML curvature of the MFT shared less congruence. Clinical Relevance Articular surface congruity may not be a critical factor associated with improvements in wrist function following this procedure.

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Treatment of partial growth arrest using cylindrical costal osteochondral graft

Bone Abstracts ◽

10.1530/boneabs.7.p2 ◽

2019 ◽

Author(s):

Ryo Orito

Keyword(s):

Growth Arrest ◽

Osteochondral Graft

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Inferior Patella Dislocation due to Impaction in the Femoral Trochlea

Case Reports in Orthopedic Research ◽

10.1159/000516131 ◽

2021 ◽

pp. 89-92

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory

Keyword(s):

Closed Reduction ◽

Early Mobilization ◽

Patella Dislocation ◽

Type Ii ◽

Rare Presentation ◽

Femoral Trochlea ◽

Inferior Pole ◽

Locked Knee ◽

Inferior Dislocation ◽

Superior Pole

Acute inferior dislocation of the patella is a rare presentation in trauma and orthopaedics. Type II is caused by direct upward force on the inferior pole of the patella when the knee is flexed impacting the superior pole osteophyte into the intercondylar notch. Impaction in the femoral trochlea is rarely reported. A 92-year-old lady presented with locked knee held in 85° of flexion with an abnormal knee contour. Radiographs demonstrated that the upper pole of the patella was impacted in the femoral trochlea with a fracture of a superior pole osteophyte. The extensor mechanism was intact. Closed reduction is achieved under strong opioid pain relief. The patient returned to her baseline knee function within 6 weeks. Closed reduction of an inferior patellar dislocation in elderly patients is aided by superior pole osteophyte fracture and facilitates early mobilization, and avoidance of general anaesthesia.

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PHB/CHIT Scaffold as a Promising Biopolymer in the Treatment of Osteochondral Defects—An Experimental Animal Study

Polymers ◽

10.3390/polym13081232 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1232

Author(s):

Eva Petrovova ◽

Marek Tomco ◽

Katarina Holovska ◽

Jan Danko ◽

Lenka Kresakova ◽

...

Keyword(s):

Cartilage Defects ◽

Osteochondral Defects ◽

Medial Condyle ◽

Femoral Trochlea ◽

X Ray ◽

Tissue Integration ◽

Defect Site ◽

Intact Cartilage ◽

The Creation ◽

Magnetic Resonance Imaging Mri

Biopolymer composites allow the creation of an optimal environment for the regeneration of chondral and osteochondral defects of articular cartilage, where natural regeneration potential is limited. In this experimental study, we used the sheep animal model for the creation of knee cartilage defects. In the medial part of the trochlea and on the medial condyle of the femur, we created artificial defects (6 × 3 mm2) with microfractures. In four experimental sheep, both defects were subsequently filled with the porous acellular polyhydroxybutyrate/chitosan (PHB/CHIT)-based implant. Two sheep had untreated defects. We evaluated the quality of the newly formed tissue in the femoral trochlea defect site using imaging (X-ray, Computer Tomography (CT), Magnetic Resonance Imaging (MRI)), macroscopic, and histological methods. Macroscopically, the surface of the treated regenerate corresponded to the niveau of the surrounding cartilage. X-ray examination 6 months after the implantation confirmed the restoration of the contour in the subchondral calcified layer and the advanced rate of bone tissue integration. The CT scan revealed a low regenerative potential in the bone zone of the defect compared to the cartilage zone. The percentage change in cartilage density at the defect site was not significantly different to the reference area (0.06–6.4%). MRI examination revealed that the healing osteochondral defect was comparable to the intact cartilage signal on the surface of the defect. Hyaline-like cartilage was observed in most of the treated animals, except for one, where the defect was repaired with fibrocartilage. Thus, the acellular, chitosan-based biomaterial is a promising biopolymer composite for the treatment of chondral and osteochondral defects of traumatic character. It has potential for further clinical testing in the orthopedic field, primarily with the combination of supporting factors.

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A Comparison of the Compressive and Shear Stiffness of Periarticular Osteophytes, Hypertrophic Femoral Intercondylar Notch and Normal Articular Cartilage

Journal of Musculoskeletal Research ◽

10.1142/s021895779800024x ◽

1998 ◽

Vol 02 (03) ◽

pp. 247-255

Author(s):

Temitope O. Alonge ◽

Olusola O. A. Oni ◽

Colin J. Morrison

Keyword(s):

Articular Cartilage ◽

Shear Force ◽

Shear Stiffness ◽

Osteochondral Graft ◽

Intercondylar Notch ◽

Articular Cartilage Defect ◽

Hardening Material ◽

Suitable Material ◽

Femoral Intercondylar Notch ◽

Shear Characteristics

The compressive and shear stiffness of periarticular osteophytes, hypertrophic femoral intercondylar notch and normal articular cartilage were compared by obtaining force-indentation curves and applying a shear force to the cartilage/bone interface. The primary stiffness (at 0–100N load) was similar for osteophytes (391N/mm), intercondylar notch (400N/mm) and normal articular cartilage (401N/mm). By contrast, the secondary stiffness (at 100–500N load) was much higher for the intercondylar notch (493N/mm) compared to the osteophytes (410N/mm). There were two varieties of osteophytes, "pink" and "white". Compared with "pink" osteophytes, "white" osteophytes exhibited features similar to a progressively hardening material and appear to be a more mechanically suitable material as an osteochondral graft for full thickness articular cartilage defect. The shear characteristics of all the samples were similar.

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Combined use of free vascularised fibula graft and extracorporeally irradiated osteochondral graft for osteosarcoma of the proximal ulna

Oncology Letters ◽

10.3892/ol_00000024 ◽

2010 ◽

Vol 1 (1) ◽

pp. 133-135 ◽

Cited By ~ 3

Author(s):

AKIRA OGOSE ◽

TETSUO HOTTA ◽

MINORU SHIBATA ◽

HIROYUKI KAWASHIMA ◽

NAOTO ENDO

Keyword(s):

Osteochondral Graft ◽

Proximal Ulna ◽

Fibula Graft ◽

Combined Use

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Computer tomographic evaluation of talar edge configuration for osteochondral graft transplantation

Clinical Anatomy ◽

10.1002/ca.22042 ◽

2012 ◽

Vol 25 (6) ◽

pp. 773-780 ◽

Cited By ~ 7

Author(s):

Martin Wiewiorski ◽

Sebastian Hoechel ◽

Katarina Wishart ◽

André Leumann ◽

Magdalena Müller-Gerbl ◽

...

Keyword(s):

Osteochondral Graft ◽

Computer Tomographic

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Magnetic Resonance Imaging to Investigate the Clinical Applicability of the Medial Femoral Trochlea Osteochondral Flap Within the Wrist

Hand ◽

10.1177/15589447211064363 ◽

2022 ◽

pp. 155894472110643

Author(s):

Jimmy H. Daruwalla ◽

Jan Skrok ◽

Mitchell A. Pet ◽

Aviram M. Giladi ◽

James P. Higgins

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Sagittal Plane ◽

Convex Surface ◽

Radius Of Curvature ◽

Resonance Imaging ◽

Femoral Trochlea ◽

Average Ratio ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri

Background: The medial femoral trochlea (MFT) osteochondral flap is employed for reconstruction of unsalvageable scaphoid proximal pole nonunions. The convex surface of the cartilage-bearing proximal trochlea is used to replace the similarly contoured proximal scaphoid and articulate with the concave scaphoid fossa of the radius. A magnetic resonance imaging (MRI) comparison of the shape of the MFT as it relates to the native proximal scaphoid has not been previously performed. Our study aimed to quantifiably compare the shape of the MFT, proximal scaphoid, and scaphoid fossa. Methods: Using imaging processing software, we measured radius of curvature of the articular segments in MRI scans of 10 healthy subjects’ wrists and knees. Results: Compared with the scaphoid fossa, average ratio of the radius of circumference of the proximal scaphoid was 0.79 and 0.78 in the coronal and sagittal planes, respectively. Compared with the scaphoid fossa, average ratio of the radius of circumference of the MFT was 0.98 and 1.31 in the coronal and sagittal planes, respectively. The radius of curvature of the MFT was larger than the proximal scaphoid, in the coronal and sagittal planes. In the coronal plane, the MFT radius of curvature is nearly identical to the scaphoid fossa, a closer match than the scaphoid itself. In the sagittal plane, the radius of curvature of the MFT was larger than the radius of curvature of the scaphoid fossa. Conclusions: Our data suggest that the radius of curvature, in the sagittal and coronal planes, of the MFT and proximal scaphoid is disparate.

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