Capitate Shortening Osteotomy for Kienböck's Disease: A Systematic Review

Various techniques exist for lunate bone decompression and revascularization in the setting of Kienböck's disease. Capitate shortening osteotomy (CSO) shows promise as an alternative treatment option; however, there is limited literature on patient characteristics and outcomes. The present study aggregates clinical and patient-reported outcomes after isolated CSO for early-stage Kienböck's disease.

A literature search was conducted using PubMed and CINAHL between 1994 and 2024 on outcomes following isolated CSO for Kienböck's disease. The search term used was "capitate shortening osteotomy." Inclusion criteria included reported operative, radiological, or functional outcomes with a minimum 1-year follow-up. Articles were excluded if concomitant procedures (eg, radial shortening osteotomy, vascularized bone grafting) were performed.

We identified 132 abstracts and reviewed 24 full-text articles, of which 10 met inclusion criteria. These studies included 141 patients (range: 7-21). Average age was 32.8 years (range: 16-66) with average follow-up of 40.9 months (range: 12-102). All patients were Lichtman stage 2 (48.5%) or 3A (51.5%). Eight studies reported visual analogue scale scores, which improved from 6.9 to 8.4 preoperatively to 1.4 to 3.3 postoperatively. Four studies reported Disabilities of the Arm, Shoulder, and Hand scores, which improved from a range of 43.7 to 65.8 to a range of 13.5 to 38.3. Disease progression was reported in 8 studies, with an overall rate of 10.9%. Lunate revascularization was observed in 78% of patients across 4 studies.

Capitate shortening osteotomy represents a viable treatment option for pain reduction and functional improvement for Kienböck's disease. Still, failure rates remain high. Further research to identify risk factors for failure and poor outcomes is warranted.