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J Wrist Surg
DOI: 10.1055/s-0043-1772253
Procedure

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease

L. Merlini
1   Intitut de la Main, Clinique Bizet, Paris, France
,
J. Maffeis
1   Intitut de la Main, Clinique Bizet, Paris, France
2   Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
,
C. Mathoulin
1   Intitut de la Main, Clinique Bizet, Paris, France
,
B.S. Sivakumar 
1   Intitut de la Main, Clinique Bizet, Paris, France
3   Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
4   Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
5   Discipline of Surgery, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia
6   Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
› Author Affiliations Funding None.
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Abstract

Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results.

Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion.

Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs).

Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs.

Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.

Keywords

Kienbock's - arthroscopy - lunate - salvage - avascular necrosis

Note

This work was presented at Institute de la Main, Clinique Bizet, 22 bis, Rue Georges Bizet, 75116, Paris, France.




Publication History

Received: 12 April 2023

Accepted: 18 July 2023

Article published online:
11 September 2023

© 2023. Thieme. All rights reserved.

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