Kienböck's Disease - A Narrative Review of Pathophysiology, Etiology, and Classification Systems

Sep 28, 2026

Uploaded by Mabel

Kienböck’s disease involves the lunate bone and leads to avascular necrosis, yet disease progression and underlying pathophysiology remain incompletely understood. Although surgical management options have been studied, no consensus exists on the optimal surgical modality. This narrative review synthesizes existing literature on pathophysiology, causes, and current classification systems. Searches used PubMed, EMBASE, and Google Scholar, focusing on etiologic and classification frameworks as well as progression concepts.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction And Background

Epidemiology and historical terminology

Review

Methodology

Relevant anatomy

Review began 11/10/2025 Review ended 11/25/2025 Published 12/01/2025 © Copyright 2025 Al-Habsi. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98211 Open Access Review Article Kienböck's Disease: A Narrative Review of Pathophysiology, Etiology, and Classification Systems Ruqaiya Al-Habsi 1 1. Surgery, The Royal London Hospital, London, GBR Corresponding author: Ruqaiya Al-Habsi, [ruqaiya.habsi@gmail.com](ruqaiya.habsi@gmail.com) Abstract Kienböck’s disease affects the lunate bone and results in avascular necrosis. It remains a disease that is not widely understood in terms of disease progression and the pathophysiology surrounding it. Despite multiple studies existing about the surgical management options, there is still no consensus about the ideal surgical modality for it. In this narrative review, the aim was to read and summarise existing literature about the pathophysiology, causes, and current classification systems. The search databases used included PubMed, EMBASE, and Google Scholar with search words, including “Kienböck”,“Kienböck disease”,“lunate avascular necrosis”,“Lichtman classification”,“Kienböck classification”, ‘Kienböck litigation”,“avascular necrosis”. The majority of published research focused mainly on the treatment options and history of the disease, with a limited number of papers about the etiology, pathophysiology, and progression. Categories: Trauma, Orthopedics Keywords: avascular necrosis, avascular necrosis (avn), kienböck disease, kienböck 's disease, lunate bone Introduction And Background Avascular necrosis of the lunate bone is known as Kienböck’s disease (KD), first explained in 1910 by Robert Kienböck [1-3]. KD occurs due to disturbance to the lunate blood supply, which causes necrosis, structural collapse, degenerative changes to the surrounding carpal joints, and osteoarthritis [1,4] . It mainly affects adults between 20 and 40 years of age and is more common in males, and patients usually have a previous trauma [5] . It is known by multiple names historically, usually in relation to the aetiology, and these include lunatemalacia, aseptic necrosis, osteochondritis, osteitis, and traumatic osteoporosis of the lunate. The main current aetiology thought to be causing KD is aseptic lunate necrosis [6] . A large cross-sectional review of 51,071 patients over an 11-year inclusion period reported a prevalence of 0.27%, with 37% of cases being incidental cases and asymptomatic patients [7] . Another study based on a retrospective review of 150,000 plain radiographs showed a low incidence of KD, with an estimated seven in 100,000 patients, making it an uncommon disease [3] . The exact cascade of events causing KD has not been fully understood. Various theories exist about vascular perfusion, anatomical variations, repeated trauma or microfractures, and systemic disease [8] . Prior to the discovery and development of plain radiographs in 1895 by Wilhelm Roentgen, a German physicist, anatomists relied on dissection of cadavers to analyse carpal bone anatomy and related pathology. These early discoveries showed various congenital abnormalities of the lunate bone, including lunarum partition, hypolunatum, epilunatum, and bipartatum [9] . It has been more than 100 years since KD was first described in literature, and there remains no consensus on the etiology of this disease [10]. The functional prognosis of KD is still unclear; it is known that, as it progresses in severity, it can result in degenerative wrist changes. Prognosis is not usually good with conservative management in adult patients; therefore, surgery is needed in the majority of cases [11]. The choice of surgical treatment varies based on the severity of the disease; however, there

FAQs

What is the main pathology in Kienböck’s disease?

Kienböck’s disease affects the lunate bone and results in avascular necrosis, followed by structural collapse and degenerative wrist changes.

How was the narrative review performed?

The review used PubMed, EMBASE, and Google Scholar up to October 2025. It included human English-language studies and excluded animal and non-clinical experimental articles, without a formal risk-of-bias assessment.

Why is there no consensus on Kienböck’s disease treatment?

Despite many studies on surgical management, the article states that ideal surgical modality and superiority between options has not been agreed upon, while prognosis with conservative management in adults is generally poor.

Sep 28, 2026

Uploaded by Mabel