ABSTRACT
Kienböck's disease is always a challenge, especially when the lunate is already fragmented.
Despite the numerous methods to treat this wrist problem, results have often not been
satisfactory. Swanson's silastic lunate prosthesis has not been a helpful solution
for most patients over the long term, and problems with artificial material have also
become apparent. A proposal to create an autogenous microvascular total lunate bone
reconstruction is presented. The second metatarsophalangeal joint was used in a new
fashion to create a biologic substitute for the lunate bone. This is called a “neolunate.”
The lunate bones and neolunates created from the second metatarsophalangeal joints
of fresh cadavers were compared. The possibilities of microvascular access to create
a neolunate and its use in wrist reconstruction were studied in ten cadaveric wrists.
The lunates and neolunates were compared. After a neolunate reconstruction, the specimen
was inserted into the original cadaveric wrist and the ligamentous structures were
repaired. The necessary architecture for ligament stability to prevent subluxation
and DISI or VISI deformity was established. Radiological measurements confirmed the
neolunate as a suitable model. The result was close to normal wrist configuration.
So far, only one clinical trial using the proposed technique has been done. The proposed
microsurgical neolunate transfer needs further clinical testing to prove its potential
value. A disadvantage is that the method is technically demanding.
KEYWORDS
Microvascular joint transplantation - Kienbock's disease - lunate reconstruction -
tissue engineering - experimental surgery
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Prof. Simo Vilkki
Department of Hand and Microsurgery, Tampere University Hospital
FIN-33521 Tampere, Finland
