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Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease

  • Reza Shahryar Kamrani
    Affiliations
    Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Center of Orthopaedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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  • Ehsan Najafi
    Affiliations
    Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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  • Hamideh Azizi
    Affiliations
    Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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  • Leila Oryadi Zanjani
    Correspondence
    Corresponding author: Leila Oryadi Zanjani, MD, Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran 1411713135, Iran.
    Affiliations
    Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Center of Orthopaedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
    Search for articles by this author
Published:October 07, 2021DOI:https://doi.org/10.1016/j.jhsa.2021.07.019

      Purpose

      The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD).

      Methods

      In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n = 54) or radial osteotomy (group B; n = 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up.

      Results

      Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively.

      Conclusions

      An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD.

      Type of study/level of evidence

      Therapeutic II.

      Key words

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