Kienböck Disease: A New Algorithm for the 21st Century

Area of Science:

• Orthopedics
• Hand Surgery
• Radiology

Background:

• Kienböck disease, or avascular necrosis of the lunate, has been studied for over a century.
• Recent advancements include new classifications based on imaging, perfusion studies, and arthroscopic assessment.
• Understanding the etiology, natural history, and treatment options has significantly evolved.

Purpose of the Study:

• To introduce a novel treatment algorithm for Kienböck disease.
• To integrate osseous (Lichtman), perfusion/viability (Schmitt), and articular cartilage (Bain) classifications into a unified management strategy.
• To provide a structured approach considering the lunate's condition and its impact on the entire wrist.

Main Methods:

• Development of a new management algorithm for Kienböck avascular necrosis of the lunate.
• Incorporation of current concepts regarding the diseased lunate and its effects on wrist biomechanics.
• Consideration of multiple classification systems for a comprehensive assessment.

Main Results:

• Early-stage, intact lunates are managed nonoperatively, with unloading procedures if conservative treatment fails.
• Compromised lunates may be reconstructed using grafts or proximal row carpectomy (PRC).
• Advanced collapse necessitates salvage procedures, while compromised wrists allow for motion-preserving interventions.

Conclusions:

• The algorithm stratifies treatment based on lunate integrity, viability, and articular cartilage status.
• Treatment decisions must balance objective pathoanatomical factors with patient-specific and surgeon-specific considerations.
• The goal is to optimize functional outcomes through tailored interventions, from nonoperative management to salvage procedures.