History Page: Leaders in MSK Radiology

AbstractRobert Kienböck (1871–1953) may be regarded as one of the first musculoskeletal radiologists who began his clinical and scientific work 2 years after the discovery of X-rays. He lent his name to Kienböck's disease, a traumatic malacia and osteonecrosis of the lunate, and to several other eponyms of diseases, devices, and parameters in radiology and radiation oncology. With his meticulous analysis of radiographic images of the highest quality, he anticipated many theories that were proposed in later decades.

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Ulnar Variance in Kienböck’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90275-5 ◽

1986 ◽

Vol 11 (2) ◽

pp. 258-260

Author(s):

S. S. KRISTENSEN ◽

E. THOMASSEN ◽

F. CHRISTENSEN

Keyword(s):

Bone Formation ◽

Mean Value ◽

Observation Time ◽

Ulnar Variance ◽

X Rays ◽

Lunate Bone ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

The Mean ◽

Kienbock’S Disease

Forty four patients with forty seven wrists suffering from Kienböck’s disease were re-examined. The mean observation time was 20.5 years. In all forty seven wrists the treatment had been immobilization. Using a standard X-ray projection, and a reliable method of ulnar variance measuring, the ulnar variance was determined by three observers independently. Comparing the result with the ulnar variance in normal wrists we found the so-called “ulnar minus variant” overrepresented in patients with Kienböck’s disease. However, comparing X-rays taken at the time of diagnosis with X-rays at re-examination, we found in eight out of forty seven wrists that a subchondral bone formation in the distal radius opposite the lunate bone had taken place. This bone formation will tend to enhance the negative value of ulnar variance measurements, and suggests an explanation of the overrepresentation of “ulnar minus variants” in Kienböck’s disease. Excluding these eight wrists from the material and comparing the mean ulnar variance value in the remaining thirty nine wrists with the mean value in normal wrists no statistical difference was shown. Based on these observations it seems unlikely that the “ulnar minus variant” has any bearing on the cause of Kienböck’s disease.

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Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

Journal of Wrist Surgery ◽

10.1055/s-0039-1688947 ◽

2019 ◽

Vol 08 (04) ◽

pp. 264-267 ◽

Cited By ~ 1

Author(s):

J. C. Botelheiro ◽

Silvia Silverio ◽

Ana Luísa Neto

Keyword(s):

The Other ◽

Stage Iiib ◽

X Rays ◽

Carpal Collapse ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

The Past ◽

Shortening Osteotomy ◽

Flexion Extension ◽

Kienbock’S Disease

Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion–extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock’s disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.

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Kienböck’s Disease — Late Results by Non-Surgical Treatment

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90171-3 ◽

1986 ◽

Vol 11 (3) ◽

pp. 422-425

Author(s):

S. S. KRISTENSEN ◽

E. THOMASSEN ◽

F. CHRISTENSEN

Keyword(s):

Treated Group ◽

Late Results ◽

X Rays ◽

Efficient Treatment ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Surgical Methods ◽

Radiocarpal Joint ◽

Kienbock’S Disease

Two groups of patients with Kienböck’s disease were followed. Twenty-three wrists had been immobilised with plaster and twenty-six had no treatment. At follow up there was a marked improvement in both groups. Eighty-three percent of the wrists in the new treated group were pain free, or reported pain only on heavy work, and in the nontreated group this was valid for 77%. Examining X-rays at follow up we did not find a single wrist in which the lunate was normal or less deformed than at the time of diagnosis. In all forty-nine wrists the lunate was deformed and in 67% osteoarthrosis in the radiocarpal joint was evident. It is concluded, that Kienböck’s disease has a naturally benign course, the remaining symptoms at follow-up might be caused by osteoarthrosis and nothing seems to be gained by rigorous immobilisation. If pain persists efficient treatment must be based on surgical methods.

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ARTHROSCOPIC ASSESSMENT OF THE WRIST WITH KIENBÖCK’S DISEASE

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182605208269 ◽

2018 ◽

Vol 26 (5) ◽

pp. 286-289

Author(s):

Guilherme Augusto Silva Amariz ◽

Maria Virginia Arranz Abreu ◽

Bruno Azevedo Veronesi ◽

Marcelo Rosa de Rezende

Keyword(s):

Carpal Bones ◽

Wrist Arthroscopy ◽

X Rays ◽

Level Of Evidence ◽

Surgical Decision ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Surgical Decision Making ◽

Lunate Necrosis ◽

Kienbock’S Disease

ABSTRACT Objective: Treatment of Kienböck's disease is challenging and the variability of results, despite the surgical technique, shows that there must be other aspects that can influence outcomes. The objective of this study is determine, through arthroscopic approach, the pattern of impairment of the carpal bones in Lichtman stage III patients. Method: Wrist arthroscopy was performed in patients with symptoms and evidence of lunate necrosis on x-rays, with signs of 3A and 3B stages. The Outerbridge classification was used to grade the articular status of the carpal bones. Results: Fifteen patients with stage 3 disease were assessed, five of whom were staged as type 3A and ten as 3B using the Lichtman stages. According to the Outerbridge classification, the lunate sulcus was the most affected with means of 2.8 at 3A and 2.9 at 3B. Other areas were significantly less affected with means of 1.1 and 1.3, respectively. Conclusion: Arthroscopic assessment of the wrist could aid in surgical decision making, offering more details on cartilage status in stage 3 Kienböck's disease. Level of Evidence III, Study of nonconsecutive patients, without consistently applied reference “gold” standard.

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RELIABILITY OF LICHTMAN'S CLASSIFICATION FOR KIENBÖCK'S DISEASE IN 99 SUBJECTS

Hand Surgery ◽

10.1142/s0218810411005035 ◽

2011 ◽

Vol 16 (01) ◽

pp. 15-18 ◽

Cited By ~ 3

Author(s):

Masaki Shin ◽

Masahiro Tatebe ◽

Hitoshi Hirata ◽

Shukuki Koh ◽

Takaaki Shinohara

Keyword(s):

Classification System ◽

Wrist Joint ◽

Interobserver Reliability ◽

Clinical Settings ◽

X Rays ◽

New Classification ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease. Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study. Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228). Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

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Anatomical Risk Factors for Keinböck’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90201-p ◽

1993 ◽

Vol 18 (1) ◽

pp. 70-75 ◽

Cited By ~ 62

Author(s):

S. TSUGE ◽

R. NAKAMURA

Keyword(s):

Risk Factors ◽

At Risk ◽

Discriminant Analysis ◽

Normal Subjects ◽

X Rays ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Radial Inclination ◽

Normal Males ◽

Kienbock’S Disease

Contralateral unaffected wrists from 41 males with Kienböck’s disease were compared with wrists from 66 normal males. From X-rays, various features of the lunate and radius were measured. In patients with Kienböck’s disease, the lunate tended to be smaller and inclined more radially than in normal subjects and the radial inclination was flatter. Discriminant analysis showed that 85% of the unaffected contralateral wrists in patients with Kienböck’s disease and 74% of the wrists in normal subjects were accurately discriminated to their respective groups. It may be possible to identify subjects who are at risk for Kienböck’s disease prior to onset using discriminant analysis.

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Juvenile Lunatomalacia—Is this Kienböck’s Disease?

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.12.010 ◽

2004 ◽

Vol 29 (3) ◽

pp. 286-290 ◽

Cited By ~ 11

Author(s):

M. CVITANICH ◽

M. SOLOMONS

Keyword(s):

Stage Iii ◽

Complete Revascularization ◽

X Rays ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Clinical Recovery ◽

Mri Scans ◽

Normal Architecture ◽

Kienbock’S Disease

An 8-year-old boy with stage III Kienböck’s disease was treated by immobilization of the wrist. He made a complete clinical recovery and serial X-rays and MRI scans demonstrated complete revascularization of the lunate which regained near normal architecture.

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Bone Morphogenetic Protein as an Adjuvant in the Treatment of Kienbock’s Disease by Vascular Pedicle Implantation

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408090394 ◽

2008 ◽

Vol 33 (3) ◽

pp. 317-321 ◽

Cited By ~ 6

Author(s):

N. F. JONES ◽

E. E. BROWN ◽

E. VÖGELIN ◽

M. R. URIST

Keyword(s):

Bone Morphogenetic Protein ◽

Vascular Supply ◽

Complete Relief ◽

X Rays ◽

Mri Scan ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Morphogenetic Protein ◽

Structural Matrix ◽

Kienbock’S Disease

This case report documents the first use of bone morphogenetic protein (BMP) as an adjuvant to revascularisation with a first dorsal metacarpal arterio-venous pedicle in the treatment of a patient with Stage III Kienbock’s disease. The patient had complete relief of her symptoms of wrist pain by 8 months postoperatively, when X-rays showed no further evidence of lunate collapse and an MRI scan demonstrated islands of revascularisation. It is impossible to prove unequivocably that BMP contributed to the result seen in this one patient, but this adjuvant concept is based on experimental evidence demonstrating that optimal bioengineering of vascularised bone is dependent on four factors – a structural matrix, progenitor cells, BMP and a vascular supply, and BMP may play a future role in promoting new bone formation in Kienbock’s disease.

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