Clinical, Functional, and Radiological Outcomes of Core Decompression in Kienböck's Disease: A Comprehensive...

Kienböck's disease (KD) is a progressive, typically unilateral condition primarily affecting young male manual laborers, causing pain and impaired wrist function. This comprehensive narrative review synthesizes the existing literature to assess clinical, functional, and radiological outcomes of Metaphyseal core decompression (MCD) in KD patients.

A comprehensive narrative review of the literature was conducted in November 2024 using PubMed, Cochrane Library, Google Scholar (top 20 result pages), and Web of Science to identify studies on core decompression for Kienböck's disease. Eligible articles were qualitatively synthesized with respect to clinical, functional, and radiological outcomes.

Eighteen studies comprising 382 patients (mean age 34.5 years) across Lichtman stages I-IIIb were reviewed. MCD techniques were associated with improvements in clinical and functional outcomes, including VAS, DASH, MWS, and PRWE scores. Radiological findings showed variable progression that did not consistently correlate with clinical deterioration. Capitate Forage Procedure (CFP), though limited in data, seems to offer promising early-term results. Major complications were infrequently reported, and a high proportion of patients (91-100%) returned to work. No procedure-related complications were reported in the reviewed studies, and the reoperation rate associated with MCD was relatively low, ranging from 4.2% to 8.3%. MCD may be beneficial for both young and elderly patients, including those with stage IIIb disease, and could offer socioeconomic advantages due to its minimally invasive nature and lack of implant use. MRI-detected vascular changes may suggest long-term benefits, with Schmitt's method recommended for imaging evaluation."

MCD improves pain relief, range of motion, and grip strength in both early and advanced stages. Pain relief is often observed early, contributing to patient satisfaction, and its efficacy may extend to advanced stage IIIb cases, enabling most patients to return to work. MRI assessments suggest possible long-term vascular benefits. MCD is considered less invasive than RSO, with potential benefits that may justify further cadaveric studies to refine arthroscopic techniques.