Document Type : SYSTEMATIC REVIEW
Authors
1
FEBHS, Department of Plastic, Hand & Reconstructive Surgery, Klinikum Bremen-Mitte, Göttingen University of Medical Science, Bremen, Germany
2
Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3
Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
4
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5
Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/abjs.2025.89723.4065
Abstract
Abstract
Objectives: Kienböck's disease (KD) is a progressive, typically unilateral condition primarily affecting young male manual laborers, causing pain and impaired wrist function. This comprehensive narrative review synthesizes the existing literature to assess clinical, functional, and radiological outcomes of Metaphyseal core decompression (MCD) in KD patients.
Methods: A comprehensive narrative review was conducted using PubMed, Cochrane Library, Google Scholar (first 20 pages), and Web of Science in November 2024 to identify studies on core decompression in Kienböck’s disease. Eligible articles were qualitatively synthesized based on clinical, functional, and radiological outcomes.
Results: Eighteen studies comprising 382 patients (mean age 34.5 years) across Lichtman stages I–IIIb were reviewed. MCD techniques appear to be associated with improvements in clinical and functional outcomes, such as improvements in VAS, DASH, MWS, and PRWE indices. Radiological assessments suggested variable progression, which may not correlate directly with clinical deterioration. Capitate Forage Procedure (CFP), though limited in data, seems to offer promising early-term results. Major complications were not commonly reported, and a high proportion of patients (91–100%) reportedly returned to work. No procedure-related complications were reported in the reviewed studies, and the reoperation rate associated with MCD was relatively low, ranging from 4.2% to 8.3%. MCD may be beneficial for both young and elderly patients, including those in stage IIIb, and could offer socioeconomic advantages due to its minimally invasive nature and lack of implant use. MRI-based vascular changes might indicate long-term benefits, and Schmitt’s method is suggested for imaging.
Conclusion: MCD appears to improve pain relief, range of motion, and grip strength in both early and advanced stages. Pain relief is often observed early, contributing to patient satisfaction, and MCD's efficacy may extend to advanced stage IIIb, allowing most patients to resume their primary occupations. Long-term effects on vascularity have been suggested in MRI assessments. MCD is considered less invasive than RSO, with potential benefits that may warrant further cadaveric studies to optimize arthroscopic techniques.
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