The Use of MRI Modeling to Enhance Osteochondral Transfer in Segmental Kienböck's Disease

Kienböck's disease, defined as avascular necrosis of the lunate, is a relatively rare condition with a poorly understood etiology. Conservative and invasive treatments for Kienböck's disease exist, including wrist immobilization, surgical joint-leveling procedures, vascularized bone grafting, proximal row carpectomy, and total wrist arthrodesis. Staging Kienböck's disease using radiography assumes near complete avascularity of the lunate. The staging distinguishes only the "state of collapse" in an ordinal classification scheme and does not allow localization or indicate partial involvement of the lunate, which the image contrast from MRI may provide. In this short communication, we report the treatment of a patient's Kienböck's disease by combining MRI with mathematical modeling to optimize the congruency between the curvature of donor and recipient sites of an autologous osteoarticular plug transfer. Follow-up MRI and radiographs at 1 year postoperatively demonstrated gradual graft incorporation and bone healing. The purpose of this study was to describe the feasibility of a novel surgical technique. The results indicate that donor site selection for autologous osteoarticular transfer using a quantitative evaluation of articular surface curvature may be beneficial for optimizing the likelihood for restoring the radius of curvature and thus joint articulation following cartilage repair.