Kienbock’s Disease

Kienbock’s disease is a rare disease of the wrist, resulting in avascular necrosis of the lunate. The etiology, pathogenesis, and optimal management are debated. There a number of biological and biomechanical risk factors for the disease. “At-risk” osseous morphology includes a Viegas- and Zapico-type 1 lunate and ulnar-negative variance of the wrist. “At-risk” vascular morphology includes both arterial and venous factors. A number of pathologies identified on dynamic CT study are likely to play an important role in symptoms and disease progression. Diagnosis involves clinical assessment and both basic and advanced imaging techniques. The three main classifications systems assess the chondral (Bain), osseous (Lichtman), and vascular (Schmitt) status of the lunate and wrist. When nonoperative treatment fails, there is a spectrum of surgical options available. We provide a framework and “multi-modal” algorithm for the treating surgeon, respecting the status of the patient, lunate and wrist.