Capitate Reconstruction Using the Second Metatarsal Head for Avascular Necrosis: Long-Term Clinical Validation of an Anatomically Matched Osteochondral Reconstruction

Avascular necrosis (AVN) of the capitate is a rare entity, and reconstruction of the capitate head remains challenging because restoration of lunocapitate articular congruity is difficult, particularly in advanced cases. A recent anatomical equivalence study demonstrated that the second metatarsal head (2MH) closely matches the capitate head with respect to key articular parameters. We report a case of capitate head reconstruction using a free vascularized 2MH osteochondral graft in a patient with recalcitrant AVN, who developed severe collapse of the capitate head following a failed pedicled vascularized bone graft. Surgical technique, graft orientation, and fixation are described. The patient was followed for over 5 years. At final follow-up, the patient demonstrated pain-free wrist function. Imaging showed maintained lunocapitate joint congruity without progression of degenerative changes. This case provides clinical support for the use of the 2MH as an anatomically matched osteochondral donor for capitate head reconstruction.