Clinical, Functional, and Radiological Outcomes of Core Decompression in Kienböck’s Disease: A Comprehensive Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors

1 Department of Plastic, Hand & Reconstructive surgery, Klinikum Bremen-Mitte, Göttingen University of medical Science, Bremen, Germany

2 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

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 of the literature was conducted in November 2024 using PubMed, Cochrane Library, Google Scholar (top 20 result pages), and Web of Science to identify studies on core decompression for Kienböck’s disease. Eligible articles were qualitatively synthesized with respect to 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 were associated with improvements in clinical and functional outcomes, including VAS, DASH, MWS, and PRWE scores. Radiological findings showed variable progression that did not consistently correlate with clinical deterioration. Capitate Forage Procedure (CFP), though limited in data, seems to offer promising early-term results. Major complications were infrequently reported, and a high proportion of patients (91–100%) 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 with stage IIIb disease, and could offer socioeconomic advantages due to its minimally invasive nature and lack of implant use. MRI-detected vascular changes may suggest long-term benefits, with Schmitt’s method recommended for imaging evaluation.”
Conclusion: MCD improves 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 its efficacy may extend to advanced stage IIIb cases, enabling most patients to return to work. MRI assessments suggest possible long-term vascular benefits. MCD is considered less invasive than RSO, with potential benefits that may justify further cadaveric studies to refine arthroscopic techniques.
        Level of evidence: IV

Keywords

Main Subjects

References

  1. Kienbock R. Uber traumatische malazie des mondbeins und ihre folgezustande: Entartungsforman und kompression frakturen. Fortschr Geb Rontgenst. 1910;16:77-103.
  2. Yazaki N, Nakamura R, Nakao E, Iwata Y, Tatebe M, Hattori T. Bilateral Kienbock's disease. J Hand Surg Br. 2005;30(2):133-6. doi: 10.1016/j.jhsb.2004.09.009.
  3. Daly CA, Graf AR. Kienböck Disease: Clinical Presentation, Epidemiology, and Historical Perspective. Hand Clin. 2022;38(4):385-92. doi: 10.1016/j.hcl.2022.03.002.
  4. Arnaiz J, Piedra T, Cerezal L, et al. Imaging of Kienböck disease. AJR Am J Roentgenol. 2014;203(1):131-9. doi: 10.2214/AJR.13.11606.
  5. Therkelsen F, Andersen K. Lunatomalacia. Acta Chir Scand. 1949;97(6):503-26.
  6. Stahl S, Stahl AS, Meisner C, Rahmanian-Schwarz A, Schaller HE, Lotter O. A systematic review of the etiopathogenesis of Kienböck's disease and a critical appraisal of its recognition as an occupational disease related to hand-arm vibration. BMC Musculoskelet Disord. 2012;13:225. doi: 10.1186/1471-2474-13-225.
  7. Afshar A, Narimanian F, Tabrizi A. Carpal Tunnel Syndrome in Surgically Treated Wrists with Kienböck Disease. Arch Bone Jt Surg. 2025;13(5):266-70. doi: 10.22038/abjs.2024.83843.3814.
  8. Tsujimoto R, Maeda J, Abe Y, et al. Epidemiology of Kienböck's disease in middle-aged and elderly Japanese women. Orthopedics. 2015;38(1):e14-8. doi: 10.3928/01477447-20150105-54.
  9. Mennen U, Sithebe H. The incidence of asymptomatic Kienböck's disease. J Hand Surg Eur Vol. 2009;34(3):348-50. doi: 10.1177/1753193408098481.
  10. Golay SK, Rust P, Ring D. The Radiological Prevalence of Incidental Kienböck Disease. Arch Bone Jt Surg. 2016;4(3):220-3. doi: 10.22038/abjs.2016.5817.
  11. van Leeuwen WF, Janssen SJ, ter Meulen DP, Ring D. What Is the Radiographic Prevalence of Incidental Kienböck Disease? Clin Orthop Relat Res. 2016;474(3):808-13. doi: 10.1007/s11999-015-4541-1.
  12. Rock MG, Roth JH, Martin L. Radial shortening osteotomy for treatment of Kienböck's disease. J Hand Surg Am. 1991;16(3):454-60. doi: 10.1016/0363-5023(91)90013-2.
  13. Hultén O. Über anatomische variationen der handgelenkknochen: ein beitrag zur kenntnis der genese zwei verschiedener mondbeinveränderungen. Acta Radiologica. 1928(2):155-68. doi:10.3109/00016922809176658.
  14. Nakanishi A, Yajima H, Kisanuki O. Post-traumatic osteonecrosis of the lunate after fracture of the distal radius. J Plast Surg Hand Surg. 2014;48(6):434-6. doi: 10.3109/2000656X.2013.812763.
  15. Wilke B, Kakar S. Delayed Avascular Necrosis and Fragmentation of the Lunate Following Perilunate Dislocation. Orthopedics. 2015;38(6):e539-42. doi: 10.3928/01477447-20150603-92.
  16. Jensen CH. Intraosseous pressure in Kienböck's disease. J Hand Surg Am. 1993;18(2):355-9. doi: 10.1016/0363-5023(93)90375-D.
  17. Bain GI, MacLean SB, Yeo CJ, Perilli E, Lichtman DM. The Etiology and Pathogenesis of Kienböck Disease. J Wrist Surg. 2016;5(4):248-54. doi: 10.1055/s-0036-1583755.
  18. Schiltenwolf M, Martini AK, Mau HC, Eversheim S, Brocai DR, Jensen CH. Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck's disease). J Hand Surg Am. 1996;21(5):754-8. doi: 10.1016/S0363-5023(96)80187-0.
  19. Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienböck's disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am. 1977;59(7):899-908.
  20. Ståhl F. On lunatomalacia (Kienböck's disease) a clinical and roentgenological study, especially on its pathogenesis and the late results of immobilization treatment. Lund: Ohlsson; 1947.
  21. Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 2010;35(7):549-54. doi: 10.1177/1753193410374690.
  22. Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienböck's disease. Hand Clin. 1993;9(3):409-16.
  23. Schmitt R, Heinze A, Fellner F, Obletter N, Strühn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997;25(2):92-103. doi: 10.1016/s0720-048x(97)00065-x.
  24. Schmitt R, Kalb K. [Imaging in Kienböck's Disease]. Handchir Mikrochir Plast Chir. 2010;42(3):162-70. doi: 10.1055/s-0030-1253433.
  25. Bain GI, Begg M. Arthroscopic assessment and classification of Kienbock's disease. Tech Hand Up Extrem Surg. 2006;10(1):8-13. doi: 10.1097/00130911-200603000-00003.
  26. Bain GI, Durrant A. An articular-based approach to Kienbock avascular necrosis of the lunate. Tech Hand Up Extrem Surg. 2011;15(1):41-7. doi: 10.1097/BTH.0b013e31820e82e8.
  27. Illarramendi AA, Schulz C, De Carli P. The surgical treatment of Kienböck's disease by radius and ulna metaphyseal core decompression. J Hand Surg Am. 2001;26(2):252-60. doi: 10.1053/jhsu.2001.22928.

 

  1. Mehrpour SR, Kamrani RS, Aghamirsalim MR, Sorbi R, Kaya A. Treatment of Kienböck disease by lunate core decompression. J Hand Surg Am. 2011;36(10):1675-7. doi: 10.1016/j.jhsa.2011.06.024.
  2. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. J Hand Surg Am. 2008;33(9):1478-81. doi: 10.1016/j.jhsa.2008.06.011.
  3. Illarramendi AA, De Carli P. Radius decompression for treatment of kienböck disease. Tech Hand Up Extrem Surg. 2003;7(3):110-3. doi: 10.1097/00130911-200309000-00007.
  4. Schulz CU, Hof N, Anetzberger H. MRI Controlled Metaphyseal Core Decompression of the Distal Radius in Lunate Avascular Necrosis. HAND. 2016;11(1_suppl):119S-S. doi: 10.1142/S2424835519500346.
  5. Ali Shah F, Alam W, Hayat S, et al. Keinbock’s Disease; Metaphyseal Core Decompression of Distal Radius-A Novel Technique to Treat. The Professional Medical Journal. 2016;23:1127-31. doi: 10.17957/TPMJ/16.3493.
  6. Sevimli R, Ertem K, Aslantürk O, Ari B. Mid term results of radial metaphyseal core decompression on Kienböck's disease. Eur Rev Med Pharmacol Sci. 2017;21(24):5557-61. doi: 10.26355/eurrev_201712_13992.
  7. De Carli P, Zaidenberg EE, Alfie V, Donndorff A, Boretto JG, Gallucci GL. Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up. J Hand Surg Am. 2017;42(9):752.e1-.e6. doi: 10.1016/j.jhsa.2017.05.017.
  8. De Carli P, Zaidenberg EE, Boretto J, Gallucci GL, Donndorff A. Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up. J Hand Surg Am. 2017;42(9):752.e1-752.e6. doi: 10.1016/j.jhsa.2017.05.017.
  9. Schulz CU. Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis. J Hand Surg Asian Pac Vol. 2019;24(3):276-82. doi: 10.1142/S2424835519500346.
  10. Ari B, Ertem K. Surgical results in Kienböck's disease. Medicine Science. 2022;11(3). doi: 10.5455/medscience.2022.02.040.
  11. Maniglio M, Zaidenberg EE, Thürig G, Gautier E, Boretto JG, P DEC. Does Age Affect the Outcomes of Core Decompression for the Treatment of Kienböck Disease? J Hand Surg Asian Pac Vol. 2022;27(1):83-8. doi: 10.1142/S2424835522500035.
  12. Maniglio M, Zaidenberg EE, Roner S, Habib N, Boretto J, P DEC. Is There a Correlation between the Radiological and Clinical Outcome after Core Decompression of the Radius for Kienböck Disease? J Hand Surg Asian Pac Vol. 2024;29(1):36-42. doi: 10.1142/S2424835524500061.
  13. Kamrani RS, Najafi E, Azizi H, Oryadi Zanjani L. Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease. J Hand Surg Am. 2022;47(7):692.e1-.e8. doi: 10.1016/j.jhsa.2021.07.019.
  14. Saremi H, Shiruei S, Moradi A. Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression. J Hand Surg Am. 2024;49(11):1143.e1-.e7. doi: 10.1016/j.jhsa.2023.02.011.
  15. Mazhar F, Moztarzadeh M, Sharifi AM, Mirzaei A. Effects of Core Decompression and Local Deferoxamine Injection on Clinical Outcomes and Revascularization of Lunate Carpal Bone in Kienböck‎ Disease: A Pilot Study. Journal of Research in Orthopedic Science. 2022;9:25-36. doi: 10.32598/JROSJ.9.1.94.3.
  16. Sadri B, Labibzadeh N, Mirmorsali L, et al. Local Transplantation of Mesenchymal Stromal Cells Is Safe and Could Alleviate Kienböck Disease's Complications: A Clinical Trial Study. Cell J. 2024;26(7):446-53. doi: 10.22074/cellj.2024.2028891.1572.
  17. Bekler HI, Erdag Y, Gumustas SA, Pehlivanoglu G. The Proposal and Early Results of Capitate Forage as a New Treatment Method for Kienböck's Disease. J Hand Microsurg. 2013;5(2):58-62. doi: 10.1007/s12593-013-0098-y.
  18. Sarı F, Ziroglu N. Comparison of the early-term clinical results of capitate forage procedure and radial shortening osteotomy in Stage 3A Kienböck's disease. Jt Dis Relat Surg. 2022;33(3):599-608. doi: 10.52312/jdrs.2022.523.
  19. Innes L, Strauch RJ. Systematic review of the treatment of Kienböck's disease in its early and late stages. J Hand Surg Am. 2010;35(5):713-7, 7.e1-4. doi: 10.1016/j.jhsa.2010.02.002.
  20. Houdek MT, Wyles CC, Martin JR, Sierra RJ. Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning. 2014;7:65-70. doi: 10.2147/SCCAA.S36584.
  21. Lee JH, Son J, Park MJ. Clinical Outcomes of Patients with Stage II and IIIA Kienböck's Disease After Undergoing Conservative Management. Indian J Orthop. 2022;56(1):79-86. doi: 10.1007/s43465-021-00451-0.
  22. Martin GR, Squire D. Long-term outcomes for Kienböck's disease. Hand (N Y). 2013;8(1):23-6. doi: 10.1007/s11552-012-9470-9.
  23. Shahryar-Kamrani R, Saremi H, Oryadi-Zanjani L, Nabian MH, Amoozadeh A, Moradi AH. Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study. Iran Red Crescent Med J. 2016;18(7):e38874. doi: 10.5812/ircmj.38874.
  24. Bain GI, Smith ML, Watts AC. Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate. Tech Hand Up Extrem Surg. 2011;15(1):66-9. doi: 10.1097/BTH.0b013e3181e1d2b4.
  25. MacLean SBM, Bain GI. Long-Term Outcome of Surgical Treatment for Kienböck Disease Using an Articular-Based Classification. J Hand Surg Am. 2021;46(5):386-95. doi: 10.1016/j.jhsa.2020.11.004.
  26. Nattrass GR, King GJ, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am. 1994;76(1):88-94. doi: 10.2106/00004623-199401000-00011.
  27. Luegmair M, Goehtz F, Kalb K, Cip J, van Schoonhoven J. Radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease. J Hand Surg Eur Vol. 2017;42(3):253-9. doi: 10.1177/1753193416676723.
  28. Nakamura R, Watanabe K, Tsunoda K, Miura T. Radial osteotomy for Kienböck's disease evaluated by magnetic resonance imaging. 24 cases followed for 1-3 years. Acta Orthop Scand. 1993;64(2):207-11. doi: 10.3109/17453679308994572.
  29. van Leeuwen WF, Pong TM, Gottlieb RW, Deml C, Chen N, van der Heijden B. Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome. J Wrist Surg. 2021;10(1):17-22. doi: 10.1055/s-0040-1714750.

 

 

 



 

The Archives of Bone and Joint Surgery
Volume 14, Issue 1
January 2026
Pages 3-5

Files

History

  • Receive Date: 03 August 2025
  • Revise Date: 03 December 2025
  • Accept Date: 06 December 2025

Share

How to cite

Statistics