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Risk Factors of Lunate Collapse in Kienböck Disease
Wouter van Leeuwen, MD1; Matthew A Tarabochia, MD1; Neal Chen, MD1; Arnold H Schuurman, MD2; David Ring, MD, PhD3
1Massachusetts General Hospital, Boston, MA, 2University Medical Center Utrecht, Utrecht, Netherlands, 3Dell Medical School, Austin, TX
Purpose: Not all patients with Kienböck disease progress to collapse of the lunate and carpal malalignment, but it’s difficult to determine which patients are at risk. The etiopathogenesis is unknown, but some theories implicate mechanical influences on the lunate. We aimed to identify demographic or anatomical factors associated with lunate and carpal collapse.
Methods: We included all 195 eligible patients with Kienböck disease with available posteroanterior and lateral radiographs, and compared the mean age, ulnar variance, radial height, radial (ulnarward) inclination, palmar tilt, and anteroposterior distance among the different Lichtman stages of Kienböck disease using Analysis of Variance and ordinal logistic regression.
Results: We found that patients with more negative ulnar variance had more advanced stages of Kienböck disease (adjusted OR, 1.4; P < .001). An increase in age was also independently associated with a higher Lichtman stage of Kienböck disease (adjusted OR, 1.02; P = .025).
Conclusion: Our study shows an association between both age and negative ulnar variance and progressive lunate collapse in patients with Kienböck disease. We support the theory that altered force transmissions in the wrist due to negative ulnar variance play a role in the progression to collapse of a lunate that is already affected by Kienböck disease. If this is the case, perhaps more advanced and symptomatic cases are diagnosed, which could create a false perception that ulnar negativity is causative of Kienböck disease. Additional long-term study is needed to confirm the
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