Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression

Hossein Saremi; Sepehr Shiruei; Abbas Moradi

doi:10.1016/j.jhsa.2023.02.011

Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression

J Hand Surg Am. 2023 Mar 25:S0363-5023(23)00114-4. doi: 10.1016/j.jhsa.2023.02.011. Online ahead of print.

Authors

Hossein Saremi¹, Sepehr Shiruei², Abbas Moradi³

Affiliations

¹ Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
² Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Electronic address: s.shiroei@umsha.ac.ir.
³ Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.

PMID: 36973101
DOI: 10.1016/j.jhsa.2023.02.011

Abstract

Purpose: This study evaluated the mid-term functional and radiological results of arthroscopic lunate core decompression for treating Kienböck disease.

Methods: In a prospective cohort study, 40 patients with a confirmed diagnosis of Kienböck disease (Lichtman stages II to IIIb) underwent arthroscopic core decompression of the lunate bone. A cutting bur was used through the trans-4 portal with visualization from the 3-4 portal after synovectomy and debridement of radiocarpal joint using a shaver from the 6R portal. Disabilities of Arm, Shoulder, and Hand and visual analog scale scores, wrist range of motion, grip strength, radiological changes of Lichtman classification, carpal height ratio, and scapholunate angle were evaluated before and two years after the surgery.

Results: The mean of Disabilities of Arm, Shoulder, and Hand score improved from 52.5 ± 13 to 29.2 ± 16.3. The visual analog scale score also improved from 7.6 ± 1.8 to 2.7 ± 1.9. There was also an improvement in hand grip strength from 6.6 ± 2.7 kg to 12.3 ± 3.1 kg. Wrist range of motion in flexion, extension, ulnar deviation, and radial deviation improved significantly. Lichtman classification remained the same in 36 (90%) patients. Carpal height did not change. Intergroup evaluation showed no functional difference in response to surgery for different radiological Lichtman stages. More improvement was observed in patients with Lichtman stage II, but was not statistically significant.

Conclusions: Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up.

Type of study/level of evidence: Therapeutic IV.

Keywords: Core decompression; Kienböck disease; lunate bone osteonecrosis; wrist arthroscopy.