OUTCOME STUDY OF ARTHROSCOPIC DECOMPRESSION OF THE LUNATE IN KIENBOCK'S DISEASE

2014 
Summary Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienbock9s Disease. Introduction The purpose of this study was to investigate the outcomes of patients suffering from avascular necrosis of the lunate, or Kienbock9s Disease, who received arthroscopic decompression to treat the ischemic lunate. Previous studies have demonstrated an elevated intraosseus pressure in the ischemic lunate, and it has been hypothesised that ischemia in the lunate is secondary to this elevated pressure and subsequent venous congestion, as opposed to diminished arterial supply. Based on this work we have used decompression of the lunate to prevent progression of the disease. Patients and Methods 21 patients, (22 wrists), reported to a single surgeon with a chief complaint of unremitting wrist pain and the subsequent diagnosis was Kienbock9s disease, stages I, II, IIIA or IIIB. Range of motion measurement and grip strength, as well as self-reported outcome measures such as Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo, were obtained preoperatively and post operatively at 2, 7 and 12 months. The patients were treated operatively with arthroscopic decompression of the lunate. The lunate was approached dorsally at the interosseous lunotriquetral and the scapholunate ligament areas with an arthroscopic shaver until brisk bleeding was achieved upon deflating the tourniquet. In some cases, the core of the lunate had to be penetrated with a 45 k-wire until bleeding was obtained. Of the 22 wrists treated arthroscopically with lunate decompression, 18 had both pre-surgical and post-surgical follow-up evaluations. Results The patients who underwent lunate arthroscopic decompression surgery demonstrated a statistically significant improvement in DASH score at 7 and 12 months postoperatively (p Conclusion This study demonstrates the clinical outcome of arthroscopic decompression of the lunate in patients suffering from Kienbock9s Disease using the patient9s subjective evaluations as well as range of motion and grip strength measurements. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienbock9s Disease using a less invasive surgical intervention.
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