The proper treatment of Kienböck’s disease, a disorder that displays slow progression with eventual collapse of the lunate and alteration of the surrounding carpal architecture, requires an understanding of its aetiology and natural history. A reproducible classification system assists the surgeon in making appropriate treatment choices. In this discussion, we review the history and rationale for the four-stage step-wise classification system, along with our current treatment algorithm. We also discuss emerging classification systems and speculate on future directions in treatment and research.
Arco News.Association research circulation osseous (ARCO): committee on terminology and classification. ARCO News. 1992, 4: 41–46.
2.
BainGIBeggM. Arthroscopic assessment and classification of Kienböck’s disease. Tech Hand Up Extrem Surg. 2006, 10: 8–13.
3.
BraunRM. Pronator pedicle bone grafting in the forearm and proximal carpal row. Orthop Trans. 1983, 7: 35–35.
4.
DecoulxPMarchandMMinetPRazemonJP. Kienbock's disease in miners; clinical & pathogenic study with analysis of 1330 X-rays of the wrist. Lille Chir. 1957, 12: 65–81.
5.
GelbermanRHBaumanTDMenonJAkesonWH. The vascularity of the lunate bone and Kienböck’s disease. J Hand Surg Am. 1980, 5: 272–78.
6.
GoldfarbCAHsuJGelbermanRHBoyerMI. The Lichtman classification for Kienböck’s disease: an assessment of reliability. J Hand Surg Am. 2003, 28: 74–80.
7.
HoriYTamaiS. Blood vessel transplantation to bone. J Hand Surg Am. 1979, 4: 23–33.
8.
HulténO. Über anatomische variationen der handgelenkknochen. Acta Radiol Scand. 1928, 9: 155–68.
9.
JafarniaKCollinsEDKohlHW3rdBennettJBIlahiOA. Reliability of the Lichtman classification of Kienböck’s disease. J Hand Surg Am. 2000, 25: 529–34.
10.
JensenCHThomsenKHolst-NielsenF. Radiographic staging of Kienböck’s disease. Poor reproducibility of Stahl’s and Lichtman’s staging systems. Acta Orthop Scand. 1996, 67: 274–76.
11.
JudetRRoy-CamilleRGuillamonJL. Treatment of pseudarthrosis of the carpal scaphoid by pediculated graft. Rev Chir Orthop Reparatrice Appar Mot. 1972, 58: 699–705.
12.
LeeM. The intraosseous arterial pattern of the carpal lunate bone and its relation to avascular necrosis. Acta Orthop Scand. 1963, 33: 43–55.
13.
LichtmanDMAlexanderAHMackGRGuntherSF. Kienböck’s disease – update on silicone replacement arthroplasty. J Hand Surg Am. 1982, 7: 343–47.
14.
LichtmanDMMackGRMacDonaldRIGuntherSFWilsonJN. Kienböck’s disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am. 1977, 59: 899–908.
15.
LuoJDiaoE. Kienböck’s disease: an approach to treatment. Hand Clin. 2006, 22: 465–73.
16.
PaksimaNCanedoA. Kienböck’s disease. J Hand Surg Am. 2009, 34: 1886–89.
17.
PeltierLF. The classic. Concerning traumatic malacia of the lunate and its consequences: degeneration and compression fractures. Privatdozent Dr. Robert Kienböck. Clin Orthop Relat Res. 1980, 149: 4–8.
18.
SaffarP. Replacement du semi-lunaire par le pisiforme: Description d'une nouvelle technique pour le traitement de la maladie de Kienbock. Ann Chir Main. 1982, 1: 276–79.
19.
SchiltenwolfMMartiniAKMauHCEversheimSBrocaiDRJensenCH. Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck’s disease). J Hand Surg Am. 1996, 21: 754–58.
20.
SchmittRHeinzeAFellnerFObletterNStruhnRBautzW. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997, 25: 92–103.
21.
SchmittRKrimmerH. Osteonecrosis of the hand skeleton. In: SchmittRUlrichL (Eds.) Diagnostic imaging of the hand, 1st Edn. Stuttgart, New York: Georg Thieme Verlag, 2007, 351–64.
22.
SimmonsSPTobiasBLichtmanDM. Lunate revascularization with artery implantation and bone grafting. J Hand Surg Am. 2009, 34: 155–60.
23.
StåhlF. On lunatomalacia (Kienböck's disease). A clinical and roentgenological study, especially on its pathogenesis and the late results of immobilization treatment. Acta Chir Scand. 1947, 95(suppl 126):1–1.
24.
TamaiSYajimaHOnoH. Revascularization procedures in the treatment of Kienböck’s disease. Hand Clin. 1993, 9: 455–66.
25.
WhiteREJrOmerGEJr. Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus. J Hand Surg Am. 1984, 9: 181–84.
