Current Concepts in the Aetiology, Pathogenesis and Management of Kienbock’s Disease

Since the first description of “lunatomalacia” by the Viennese radiologist, Robert Kienböckthe aetiology, pathogenesis and management of Kienbock’s Disease has been debated. The disease encompasses a spectrum of age and gender but is classically considered to affect young-to-middle-aged male manual laborer’s. Both mechanical and vascular factors play a role in disease aetiology, and it is likely that a critical combination is important. Alteration in the normal homeostasis of arterial in-flow and venous out-flow may lead to ischemia of the lunate. Loading conditions of the lunate are affected by the morphology of both the lunate and the wrist, as well as occupational or functional activities of the patient. Clinical presentation is varied and depends on a number of factors, including the patient’s functional levels and disease severity. History, examination and imaging is essential when determining optimal treatment. Plain radiographs and 3D-CT scanning aid in determining the osseous component of the disease. 4D-CT scanning allows dynamic assessment of the kinematics of the Kienböck wrist. The vascular component of the disease can be assessed on MRI scanning, with or without gadolinium contrast. The chondral aspect of the disease is best assessed with arthroscopic examination. Management of the disease requires consideration of a number of factors, both patient- and surgeon-focused. An algorithm is presented in this thesis to guide the surgeon treating Kienbock’s Disease. Primary considerations to the surgeon include the age (A) of the patient, the state of the bone (B), and the state of the carpus (C). Treatment options include lunate unloading procedures, lunate reconstruction, motion-preserving procedures, and salvage procedures. We favour an arthroscopic approach for decision-making, as it allows determination of the ‘functional surfaces’ of the wrist. Both arthroscopic and open techniques can then be performed. The long-term surgical outcomes of Kienbock’s Disease is presented in a cohort of patients using an arthroscopic-based approach.

Name thesis:degree_name

MD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Medicine

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2022

Author dc:creator

• MacLean, Simon Bruce Murdoch

Advisor dc:contributor.advisor

• Pitto, Rocco

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/63446

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/63446