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Cheon, Park, Jeon, and Lee: Lunate Excision and Tendon Ball Implantation in Lichtman Stage IIIB Kienböck’s Disease in Middle-Aged Patients
Original Article

J Korean Soc Surg Hand 2015;20(3):110-118.

Published online: 11 September 2015

DOI: https://doi.org/10.12790/jkssh.2015.20.3.110

Lunate Excision and Tendon Ball Implantation in Lichtman Stage IIIB Kienböck’s Disease in Middle-Aged Patients

Sang Jin Cheon, Shi Hwan Park, Woong Ki Jeon, Dong Ho Lee

Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Pusan, Korea

Correspondence to: Sang Jin Cheon Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea TEL: +82-51-240-7531 FAX: +82-51-247-8395 E-mail: scheon@pusan.ac.kr

Received 11 June 201522 July 201526 July 2015       Accepted 27 July 2015

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Our purpose was to assess the results of lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienböck’s disease in middle-aged patients.

Methods:

Ten patients with Lichtman stage IIIB Kienböck’s disease who underwent lunate excision and tendon ball implantation and followed up at least 24 months were analyzed. There were 4 males and 6 females. The mean age at the time of surgery was 55.4 years (range, 48-67 years), and follow-up period ranged from 24 to 68 months (mean, 46 months). Radiocarpal joint pain, grip strength, return to daily living activity, range of motion were evaluated and radiologic findings of preoperative, postoperative and last follow-up were evaluated.

Results:

All patients returned to daily living activity after 6 months of surgery. At the last follow up, 8 patients had no pain and 2 patients experienced mild pain occasionally. The mean improvement of extension arc was 14.5°, and the mean flexion arc improved 8.5°. The mean grip strength was 88% of unaffected side. The mean carpal height ratio was 0.49 preoperatively, 0.47 at final followup. No patients showed osteoarthritis change at the last follow-up. The mean Cooney’s wrist function were 83, 4 patients had excellent, 4 had good, and 2 had fair.

Conclusion:

Lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienböck’s disease in middle-aged patients showed satisfactory clinical, functional and radiological results. So this can be a reasonable treatment option.

Keywords: Kienböck’s disease, Lunate, Avascular necrosis, Tendon ball implantation

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Fig. 1.
A 66-year-old female with Lichtman Class IIIB Kienbock’s disease. Third, fourth extensor compartment were found (A) and retracted to ulnar side (B). Tendon ball was made of Palmaris longus and plantaris tendons (C). After curettage of necrotic lunate bone tendon ball was inserted (D).
jkssh-20-110f1.tif
Fig. 2.
(A) Preoperative radiograph shows necrotic collapse of right lunate, Lichtman Class IIIB Kienbock’s disease. (B) Immediate postoperative radiograph shows excision of lunate, tendon transposition, temporary scaphocapitate fixation and thumb spica cast application. (C) 8 weeks postoperatively showing removal of K-wire and no residual bony fragment. (D) 45 months after surgery showing no further collapse or osteoarthritic change with calcification.
jkssh-20-110f2.tif
Fig. 3.
A 55-year-old male with Lichtman Class IIIB Kienbock’s disease (case No. 8). (A, B) Preoperative radiograph shows necrotic collapse of left lunate and ulnar negative varience. (C, D) 37 months after surgery showing no further collapse or osteoarthritic change with calcificaion.
jkssh-20-110f3.tif
Table 1.
Clinical data of 10 patients operated for Kienböck’s disease
Case Age (yr) Sex Operated hand Occupation Lichtman’s classification Tendon graft Ulnar variance Follow up period (mo) Range of motion (°)
 Postop. grip strength ratio to opposite side (%) Cooney’s wrist function score
Preop. Flex.-Ext. Postop. Flex.-Ext.
1 66 Female Left Housewife IIIB PML Zero 24 35-25 53-40 79 Fair
2 48 Female Right Cook IIIB PML Zero 40 55-44 55-45 91 Excellent
3 49 Male Right Heavy labor IIIB PML Zero 52 35-30 40-40 83 Good
4 49 Male Right Office job IIIB PML+PL Zero 38 40-45 45-55 82 Fair
5 67 Female Left Cook IIIB PML+PL Zero 60 25-30 50-45 95 Excellent
6 55 Female Right Cook IIIB PML+PL Zero 68 55-34 60-50 92 Excellent
7 60 Female Right Housewife IIIB PML+PL Zero 45 40-30 45-50 85 Good
8 55 Male Left Heavy labor IIIB PML (-) 39 45-25 54-53 95 Excellent
9 53 Female Right Housewife IIIB PML+PL (-) 43 30-25 38-45 93 Good
10 52 Male Left Office job IIIB PML Zero 51 48-30 45-40 85 Good
Ave 55.4 Male, 4 Right, 6 IIIA, 0 (-), 2 46 Flex. 40.5 Flex. 48.5 88 Excellent, 4
female, 6 left, 4 IIIB, 10 Zero, 8 Ext. 31.8 Ext. 46.3 good, 4
fair, 2

Preop., preoperative; Flex., flexion; Ext., extension; Postop., postoperative; PML, palmaris longus tendon; PL, plantaris tendon; Ave, average.

Table 2.
Postoperative and last follow-up change of carpal height ratio
Preoperative Postoperative Last follow-up
1 0.48 0.50 0.47
2 0.50 0.49 0.47
3 0.53 0.50 0.47
4 0.49 0.47 0.49
5 0.51 0.51 0.49
6 0.49 0.51 0.48
7 0.47 0.48 0.46
8 0.50 0.47 0.47
9 0.48 0.47 0.46
10 0.49 0.48 0.46
Mean 0.494 0.488 0.472
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