Plastic Surgery Research Council

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Lower Extremity Outcomes after Medial Femoral Trochlea Free Flap Harvest
Imran S. Yousaf, DO, Mitchell A. Pet, DO, Patrick E. Assi, MD, Aviram M. Giladi, MD, MS, James P. Higgins, MD.
The Curtis National Hand Center, Baltimore, MD, USA.

Purpose: The medial femoral trochlea (MFT) osteochondral free flap is used for articular reconstruction of the scaphoid and lunate. Understanding lower extremity function and patient-reported outcomes (PRO) following MFT harvest is important in evaluating this novel reconstructive option.
Methods: Inclusion criteria for this study were MFT harvest for scaphoid or lunate reconstruction by a single surgeon between 2012 and 2017, and post-operative follow-up exceeding 6 months. Medical records were reviewed for patient (sex, age, BMI) and operative details. Knee range of motion (ROM) was measured using a handheld goniometer. PROs used to assess the knee include IKDC (International Knee Documentation Committee), AKPS (Anterior Knee Pain Scale), KOOS (Knee Injury and Osteoarthritis Outcomes Score) and WOMAC (Western Ontario McMaster Universities Osteoarthritis Index). Patients were asked to return for a physical exam of the knee and to complete patient reported outcomes questionnaires (PROs). For patients unable to come for a physical exam, PROs were offered electronically. Pre- and post-operative data were compared using t-tests to quantify donor site morbidity. Multivariable modeling was used to examine patient factors that may be predictive of donor site outcomes.
Results: 45 patients were included (14 female, 31 male). Mean age was 25.4 (16-40) years and mean BMI was 28.1 (22-40). 17 returned for follow-up physical exam, and 15 had pre-operative PROs available. Mean examination follow-up was 2.6 years, and mean PRO follow-up was 3.2 years. Knee ROM did not differ between the operated and unoperated knee. When comparing pre- and post-operative scores, statistically significant donor site morbidity was detected on KOOS subscales (n=15; Pain: -5.3 points, p=0.002; Activities of Daily Living [ADL]: -2.5 points, p=0.008; Sports and Recreation: -13 points, p=0.002) and WOMAC (n=15; -3.4%, p=0.009). Changes in other scales and subscales were not statistically significant. When controlled for age and sex, higher BMI was predictive of worse postoperative function on the KOOS Pain and Symptoms subscales, as well as WOMAC scale (p<0.05; Table 1).
Conclusions: MFT harvest does not appear to restrict knee ROM after surgery. Most measures of knee function were unaffected or only slightly affected by MFT harvest; however, there may be some clinically significant donor site morbidity in the Sports and Recreation domain. Additionally, patients with higher BMI may be at risk for increased donor site morbidity.

Table 1. Multivariable Model of Postoperative Patient Reported Outcomes
Patient Reported OutcomesBMI at SurgeryAge at SurgeryMale Gender
βpβpβp
IKDC-1.190.010.280.401.180.84
Kujala/AKPS-0.430.120.350.03-1.490.70
KOOS-Pain-0.640.02-0.050.77-0.850.74
KOOS-Symptoms-0.710.030.190.333.780.31
KOOS-Activities of Daily Living-0.430.070.000.980.570.79
KOOS-Sports and Recreation-0.480.280.430.165.500.25
KOOS-Quality of Life-0.580.22-0.060.86-4.610.33
WOMAC-0.120.06-0.020.87-0.190.93
IKDC, International Knee Documentation Committee; AKPS, Anterior Knee Pain Scale; KOOS, Knee Injury and Osteoarthritis Outcomes Score; WOMAC, Western Ontario McMaster Universities Osteoarthritis Index
β, beta coefficient
Significance defined as p<0.05


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