Bone Morphogenetic Protein as an Adjuvant in the Treatment of Kienbock’s Disease by Vascular Pedicle Implantation

This case report documents the first use of bone morphogenetic protein (BMP) as an adjuvant to revascularisation with a first dorsal metacarpal arterio-venous pedicle in the treatment of a patient with Stage III Kienbock’s disease. The patient had complete relief of her symptoms of wrist pain by 8 months postoperatively, when X-rays showed no further evidence of lunate collapse and an MRI scan demonstrated islands of revascularisation. It is impossible to prove unequivocably that BMP contributed to the result seen in this one patient, but this adjuvant concept is based on experimental evidence demonstrating that optimal bioengineering of vascularised bone is dependent on four factors – a structural matrix, progenitor cells, BMP and a vascular supply, and BMP may play a future role in promoting new bone formation in Kienbock’s disease.