Reconstruction of proximal pole scaphoid nonunion using medial femoral trochlea osteochondral free flap is indicated in young active patients for whom salvage procedures are not ideal. This article reviews the outcomes data available in the literature and provides a brief report of clinical, radiographic, and patient-reported outcomes for the subset of our patients with greater than 3 years postoperative follow-up. The present literature suggests that medial femoral trochlea reconstruction for proximal pole scaphoid nonunion can restore radiocarpal anatomy, prevent progressive carpal collapse, improve function, and relieve pain without causing wrist stiffness, weakness, or excessive donor site morbidity in the short and medium term.