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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References
- Kienbock’s disease.Chir Main. 2015; 34: 4-17
- Kienbock disease: a new algorithm for the 21st century.J Wrist Surg. 2017; 6: 2-10
- Systematic review of the treatment of Kienbock’s disease in its early and late stages.J Hand Surg Am. 2010; 35 (717.e1–4): 713-717
- Kienbock’s disease: the role of silicone replacement arthroplasty.J Bone Joint Surg Am. 1977; 59: 899-908
- The classification and treatment of Kienbock’s disease: the state of the art and a look at the future.J Hand Surg Eur. 2010; 35: 549-554
- Kienbock disease.J Hand Surg Am. 2012; 37: 1942-1952
- Long-term outcome of surgical treatment for Kienböck disease using an articular-based classification.J Hand Surg Am. 2021; 46: 386-395
- Ten questions on Kienbock’s disease of the lunate.J Hand Surg Eur. 2010; 35: 538-543
- Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienbock disease.J Hand Surg Am. 2013; 38: 289-296
- What is the radiographic prevalence of incidental Kienbock disease?.Clin Orthop Relat Res. 2016; 474: 808-813
- an approach to treatment.Hand Clin. 2006; 22 (abstract vi): 465-473
- The management of Kienbock disease: a survey of the ASSH membership.J Wrist Surg. 2015; 4: 43-48
- Kienbock disease in the skeletally immature patient.J Hand Surg Am. 2018; 43: 465-469
- Kienbock disease.Orthop Clin North Am. 2014; 45: 141-152
- Operative treatment with radial shortening in Kienböck’s disease.Orthopedics. 2001; 24: 365-371
- Treatment of Kienbock disease by lunate core decompression.J Hand Surg Am. 2011; 36: 1675-1677
- Radial osteotomy for late-stage Kienbock’s disease. Wedge osteotomy versus radial shortening.J Bone Joint Surg Br. 2002; 84: 673-677
- Clinical outcome of lateral wedge osteotomy of the radius in advanced stages of Kienböck’s disease.Clin Orthop Surg. 2017; 9: 355-362
- Arthroscopic debridement for the treatment of Kienbock’s disease.Arthroscopy. 1999; 15: 12-19
- Arthroscopic assessment and classification of Kienbock’s disease.Tech Hand Up Extrem Surg. 2006; 10: 8-13
- Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate.Tech Hand Up Extrem Surg. 2011; 15: 66-69
- Osteotomy of the radius without shortening for Kienböck disease: a 10-year follow-up.J Hand Surg Am. 2012; 37: 2221-2225
- Trans-4 portal as a new portal for accessing the lunate in wrist arthroscopy: a cadaveric study.Iran Red Crescent Med J. 2016; 18e38874
- An alternative method for determination of the carpal height ratio.J Bone Joint Surg Am. 1994; 76: 88-94
- Validity and reliability of the Persian version of shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick-DASH).Int J Prev Med. 2015; 6 (59–59)
- Surgical approaches to the distal radius.Hand (N Y). 2011; 6: 8-17
- The role of wrist arthroscopy in Kienbock disease.Hand Clin. 2017; 33: 727-734
- Imaging and staging of avascular osteonecroses at the wrist and hand.Eur J Radiol. 1997; 25: 92-103
- Kienbock disease: moving forward.J Hand Surg Am. 2016; 41: 630-638
- Kienböck’s disease with non-negative ulnar variance: treatment with combined radial wedge and shortening osteotomy.Der Orthopäde. 2019; 48: 96-101
Article info
Publication history
Published online: October 07, 2021
Accepted:
July 14,
2021
Received:
June 6,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
