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J Wrist Surg 2016; 05(04): 255-260
DOI: 10.1055/s-0036-1584546
Special Review: Kienböck Disease
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment

Gregory I. Bain
1   Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
2   Flinders Medical Centre, Adelaide, South Australia, Australia
,
Simon B. M. MacLean
2   Flinders Medical Centre, Adelaide, South Australia, Australia
3   Department of Orthopaedics, Flinders University, Adelaide, South Australia, Australia
,
Wing-Lim Tse
4   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
,
Pak-Cheong Ho
4   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
,
David M. Lichtman
5   Uniformed Services University, Bethesda, Maryland
6   Department of Orthopaedic Surgery, University of North Texas, Health Science Center, Fort Worth, Texas
› Author Affiliations
Further Information

Publication History

31 March 2016

17 May 2016

Publication Date:
20 June 2016 (online)

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Abstract

The assessment and management of Kienböck Disease (KD) has always been a conundrum. The Lichtman classification has traditionally been used to guide treatment based on imaging. Arthroscopy provides a direct visualization of the articular surface, allows probing of the surfaces, and enables minimally invasive techniques to be performed.

The Lichtman-Bain classification is a new classification that takes into account the osseous, vascular, and cartilage aspects of the lunate and the secondary effects on the wrist. It identifies the important prognostic factors including age, the status of the lunate, and the status of the wrist.

With arthroscopy, the articular surfaces of the lunate can be assessed to better understand the status of the lunate. The lunate can be defined as intact, compromised, or not reconstructable. If the lunate is intact then lunate decompression (forage) and arthroscopic assisted bone grafting can be performed. If the lunate facet and capitate are functional, then a proximal carpectomy can be performed. This can be performed as an arthroscopic procedure.

Assessment of the wrist includes assessment of the adjacent articular surfaces of the central column articulations (radiocarpal and midcarpal articulations). Instability of the proximal carpal row can also be assessed. The radioscaphoid articulation is often preserved except in late KD, which allows the scaphocapitate fusion to be a good surgical option. This can now be performed as an arthroscopic procedure. Once the radioscaphoid articulation is degenerate, a salvage procedure is required.

Keywords

Kienböck disease - avascular necrosis - classification - treatment - wrist