Kienböck Disease: Last Frontier of the Wrist

Kienböck disease is a very famous, but mysterious disease. Although more than 100 years have already passed since the discovery of this disease by Dr. Robert Kienböck, the pathomechanics of the necrosis of the lunate are still unknown. Several causes of Kienböck disease, that is, deficiency of blood supply in the lunate, overloading of the lunate or avascular necrosis secondary to microfracture have been reported, however, the real pathogenesis has not been revealed yet. Radiographs have been used to diagnose this disease since its discovery in 1910. Magnetic resonance imaging (MRI) is now very popular for making the diagnosis of Kienböck disease, which is based on a low-signal intensity on a T1-weighted MRI due to a decrease in the volume of the marrow fat tissue. An MRI cannot directly demonstrate bone necrosis therefore we continue to search for direct methods of imaging the bone vascularity.

Many treatments for Kienböck disease are described, such as lunate resection, vascularized bone grafting, radial shortening/radial wedge osteotomy, capitate shortening, partial wrist fusion, and proximal row carpectomy, with acceptable results in suitable patients. However, we still do not have the perfect answer for treatment of Kienböck disease. The selection of treatment is still based on Lichtman X-ray classification. Wrist arthroscopy has the potential to change the algorithm for treatment based on a direct examination of the functional articular surfaces.

In this issue, the special focus includes unique articles of Kienböck disease. Two articles from Japan include a clinical study of radial shortening/closed wedge osteotomy and a study of the use of vascularized bone grafting. The third article is a long-term radiographic study of lunate excision. A newly developed modern micro computed tomography analysis was also included. Please enjoy a variety of diagnosis and treatment option for Kienböck disease.