Correlation of Radiographic and Arthroscopic Staging in Kienböck Disease: Impact on Treatment Decisions and Functional Outcomes.

Abstract

Background: The prognosis of Kienböck disease (KD) depends upon the extent of damage to the articular surface of the lunate and its adjacent articulations. Arthroscopy offers valuable information for management and decision-making by revealing the status of the articular surface, which radiographs cannot visualise. Methods: This study on KD assessed 10 patients, correlating radiographic and arthroscopic evaluations to enhance diagnostic accuracy and determine the decision-making, which may result in improved functional outcomes for patients. Results: Findings have shown that arthroscopy often reveals critical details not visible by imaging, influencing surgical planning. Notably, the management plan changed in 50% of the cases following arthroscopic assessment in our series. The radiological evaluations indicated changes in the lunate, carpal collapse and instability angles, while wrist arthroscopy offered further insights into cartilage damage, lunate fracture and ligament integrity. Additionally, wrist arthroscopic evaluations facilitated minimally invasive procedures, such as scapho-capitate fusion through a mini-incision, potentially resulting in a shorter recovery time and a decreased risk of complications relative to the conventional dorsal approach, thereby providing a much more satisfactory functional outcome. Conclusion: The study concludes that combining radiographic and arthroscopic data enhances comprehensive diagnostic accuracy and guides precise surgical intervention in KD. Level of Evidence: Level IV (Therapeutic).