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
