A new concept and technique for custom-made microvascular lunate bone reconstruction

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Kienböck's disease presents significant challenges, particularly with advanced lunate fragmentation.
• Current treatments, including silastic prostheses, often yield unsatisfactory long-term results and introduce material-related issues.

Purpose of the Study:

• To present a novel technique for autogenous microvascular total lunate bone reconstruction.
• To evaluate the feasibility and efficacy of a "neolunate" created from the second metatarsophalangeal joint as a biological substitute for the lunate bone.

Main Methods:

• Comparison of anatomical and radiological characteristics between native lunates and neolunates derived from cadaveric second metatarsophalangeal joints.
• Assessment of microvascular access and neolunate integration in ten cadaveric wrists.
• Evaluation of ligamentous structure repair and wrist stability post-neolunate reconstruction.

Main Results:

• Radiological measurements confirmed the neolunate as a suitable anatomical model.
• The reconstruction successfully restored ligamentous architecture, preventing subluxation and deformities (DISI/VISI).
• The resulting wrist configuration closely approximated normal anatomy.

Conclusions:

• The proposed microsurgical neolunate transfer offers a potential biological solution for Kienböck's disease.
• Further clinical investigation is required to validate the technique's long-term value, despite its technical demands.