Magnetic Resonance Imaging to Investigate the Clinical Applicability of the Medial Femoral Trochlea Osteochondral Flap Within the Wrist
Jimmy H Daruwalla, MD1, Jan Skrok, MD1, Aviram M Giladi, MD, MS2 and James P Higgins, MD3, (1)MedStar Union Memorial Hospital, Baltimore, MD, (2)The Curtis National Hand Center, Baltimore, MD, (3)The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
Introduction: The medial femoral trochlea (MFT) osteochondral flap is a technique employed for the treatment of non-salvageable 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. Despite preliminary results supporting its clinical applicability, a magnetic resonance imaging (MRI) comparison of the shape of the MFT as it relates to the native proximal scaphoid has never been performed. The goal of this study is to quantifiably compare the shape of the MFT, proximal scaphoid, and scaphoid fossa.
Methods: MRI scans of the wrist and knee of ten healthy subjects were obtained. Using imaging processing software, we measured the radius of curvature of the articular segments of interest. Ratios of these measurements of the MFT and scaphoid compared to the scaphoid fossa in multiple planes were then calculated.
Results: Compared to the scaphoid fossa, the 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 to the scaphoid fossa, the average ratio of the radius of circumference of the MFT was 0.98 and 1.31 in the coronal and sagittal planes, respectively. Based on our data, the radius of curvature of the MFT was larger than that of the proximal scaphoid, in both the coronal and sagittal planes. In the coronal plane, the MFT radius of curvature is nearly identical to the scaphoid fossa, and is a closer match than the scaphoid itself. In the sagittal plane, the radius of curvature of the MFT was actually larger than the radius of curvature of the scaphoid fossa.
Conclusion: Our data suggest that the radius of curvature, in the sagittal and coronal planes, of the MFT and the proximal scaphoid are disparate. Further clinical research is required to determine the clinical significance of these differences in patients undergoing MFT reconstruction of proximal scaphoid nonunions.
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