Kienböck Disease: Recent Advances in the Basic Science, Assessment and Treatment

Bain, Gregory I.; Yeo, Chong Jin; Morse, Levi

doi:10.1142/s0218810415400079

Cited by 32 publications

(26 citation statements)

References 81 publications

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“…In addition, a significant asymptomatic older population has been identified. 9 The lunate morphology is known to affect the kinematics of the carpus, 10 and predisposes to degeneration of the carpus. 11 The proximal articular "condyle" is the common site of KD.…”

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confidence: 99%

The Etiology and Pathogenesis of Kienböck Disease

et al. 2016

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Kienböck disease is a condition that typically occurs in the "at-risk" patient, in the "atrisk" aspect of the proximal condyle of the "at-risk" lunate. In the active male, repetitive loading causes the stress fracture that commences in the single layer proximal subchondral bone plate. The lunate fracture commences at the point the lunate cantilevers over the edge of the distal radius, and then takes on the shape of the radius. We postulate that the stress fracture violates the parallel veins of the venous subarticular plexus-leading to localized venous hypertension and subsequent ischemia and edema of the fatty marrow. The increased osseous compartment pressure further potentiates the venous obstruction, producing avascular necrosis. If the fracture remains localized, it can heal or settle into a stable configuration, so that the wrist remains functional. Fractures of the subchondral bone plate produce irregularity of the lunate articular surfaces and secondary "kissing lesions" of the lunate facet and capitate, and subsequent degeneration. The lunate collapses when the fracture is comminuted, or there is disruption of the spanning trabeculae or a coronal fracture. The secondary effect of the lunate collapse is proximal migration of the capitate between the volar and dorsal fragments, producing collapse of the entire central column. The proximal carpal row is now unstable, and is similar to scapholunate instability, where the capitate migrates between the scaphoid and lunate. The scaphoid is forced into flexion by the trapezium, however, degeneration of the scaphoid and scaphoid facet only occurs in late disease or following failed surgery. In Kienböck disease, the secondary effects of the collapsing lunate are a "compromised" wrist, including: deformity and collapse of the central column, degeneration of the central column (perilunate) articulations, proximal row instability (i.e., between the central and radial columns), and degeneration of the radial column.

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confidence: 99%

The Etiology and Pathogenesis of Kienböck Disease

et al. 2016

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“…Bain reported a pattern of pathology identified at arthroscopy on patients with KD. 7 He also reported the following:…”

Section: Diagnostic Arthroscopymentioning

confidence: 94%

“…Combining this understanding with arthroscopic assessment of the functional and nonfunctional surfaces, helps formulate the optimum management strategy for the patient. 7,8…”

Section: The Normal and Kienböck Wristmentioning

confidence: 99%

“…This is because the collapsed lunate is now distracted, creating a potential space within the lunate. 7 Debridement of loose bony fragments, chondral flaps, and synovitis is performed. This assists in understanding the extent of the lunate fragmentation and can provide symptomatic relief for the patient.…”

Section: Diagnostic Arthroscopymentioning

confidence: 99%

“…Precise arthroscopic assessment, however, remains the gold standard in assessment of the perilunate articular surfaces. [5][6][7] It must be highlighted, however, that the newer modalities are providing an improved understanding of the articular surface, and for this reason we recommend that the articular surfaces be taken into account, when determining the best treatment options.…”

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confidence: 99%

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Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment

et al. 2016

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The assessment and management of Kienb?ck 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.

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Kienbock’s Disease and Other Osteonecrosis of the Pediatric Carpus

Russo

2024

The Pediatric Upper Extremity

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Kienböck Disease: Recent Advances in the Basic Science, Assessment and Treatment

Cited by 32 publications

References 81 publications

The Etiology and Pathogenesis of Kienböck Disease

The Etiology and Pathogenesis of Kienböck Disease

Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment

Kienbock’s Disease and Other Osteonecrosis of the Pediatric Carpus

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