This protocol addresses Kienböck disease in patients aged 21 to 69 years where the lunate shows localised collapse or degeneration — classified as Lichtman stage IIIA, Schmitt MRI stage B, and Bain arthroscopic grade 1 — meaning the lunate is compromised but still has intact areas amenable to reconstruction.
The lunate in this stage has localised areas of nonfunctioning proximal articular cartilage alongside intact regions. This is a "compromised" lunate: not fully destroyed, but structurally altered. The patient falls within the working-age adult range (21–69 years), and the staging across imaging and arthroscopy (Lichtman IIIA / Schmitt B / Bain grade 1) aligns in indicating that reconstruction — rather than observation or simple debridement — is appropriate.
The ideal management centres on lunate reconstruction, aiming to restore proximal articular function and carpal height. A vascularised graft technique represents the preferred approach where feasible, though the procedure is technically demanding.
For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
A "compromised" lunate has localized areas of collapse or degeneration, but other areas that can be used to reconstruct and maintain a functional lunate.
This coincides with the Lichtman stage IIIA, Schmitt stage B, and Bain grade 1.
The lunate has localized disease, with areas of nonfunctioning proximal articular cartilage, but other parts are intact.
The ideal treatment would be localized lunate reconstruction.
This is indicated for reconstruction of the proximal lunate, and also to restore carpal height.
This is a demanding procedure, so other treatment options are required.
These include lunate salvage (PRC or lunate replacement), radioscapholunate (RSL) fusion, or scaphocapitate fusion.
DOI: 10.1055/s-0037-1604137
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