Midfoot Reconstruction for Avascular Necrosis of the Navicular Bone

Background: Avascular necrosis (AVN) of the tarsal navicular, particularly with collapse, presents a complex surgical challenge due to compromised vascularity and the need to restore medial column length. This retrospective case series evaluates three distinct surgical approaches to midfoot reconstruction in patients with navicular AVN. Methods: Three patients with navicular AVN were treated using individualized grafting strategies. Etiologies included chronic protease inhibitor use for HIV, Müller-Weiss syndrome, and post-resection of a giant cell tumor. All procedures utilized a medial utility incision with debridement to viable bleeding bone. Two cases were reconstructed using a combination of proximal tibial autograft, patellar allograft, and pluripotent stem cells. The third case employed a bone slurry of allograft and mesenchymal stem cells (MSCs) within a customized 3-D printed titanium truss. Stabilization was achieved using medial column anatomic plates and a combination of solid and cannulated screws. Patients (mean age 57.5 years; 2 males, 1 female) were assessed clinically and radiographically preoperatively and at six weeks postoperatively. The average follow-up duration was 16 months. Results: All patients achieved successful fusion with a 100% union rate. Radiographic and clinical correction was excellent, with no residual collapse. The average time to return to regular shoe gear was 6.2 weeks. No major complications were reported; one patient required partial hardware removal due to irritation. Conclusion: Midfoot reconstruction for navicular AVN using tailored grafting techniques resulted in favorable outcomes across diverse etiologies. These findings support the viability of biologically enhanced grafting and structural implants in achieving union and restoring function. Further studies are warranted to assess long-term outcomes and cost-effectiveness of these approaches.