Lunate excision combined with palmaris longus tendon ball arthroplasty for stage III Kienböck’s disease: a retrospective case series
This retrospective case series of six patients demonstrates that lunate excision combined with palmaris longus tendon ball arthroplasty is a viable surgical option for stage III Kienböck's disease, yielding satisfactory short-term pain relief and functional recovery without complications at a mean 12-month follow-up.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The human wrist is a marvel of engineering, a compact cluster of eight small bones that must move with precision while bearing the weight of our daily labor. Among these bones, the lunate sits at the very center, acting as a crucial pillar that supports the arch of the hand. When the blood supply to this tiny bone fails, it begins to die and crumble, a condition known as Kienböck's disease. As the bone collapses, the delicate architecture of the wrist falls apart, leading to severe pain, stiffness, and a loss of function. For patients in the advanced stages of this disease, where the bone has already fractured or the wrist has begun to disorganize, surgeons face a difficult choice: remove the damaged bone entirely or attempt to fuse the joint, often sacrificing movement. The challenge lies in what to do after the bone is gone; without a central pillar, the wrist tends to collapse inward, rendering the hand useless.
A team of surgeons in China recently explored a specific solution for this problem, focusing on six patients whose lunate bones had reached this critical stage of collapse. Instead of leaving a hollow space where the bone used to be, they removed the dead bone and filled the gap with a custom-made ball crafted from the patient's own tendon. This tendon, taken from the forearm, was braided into a tight sphere and placed into the empty socket. The goal was to act as a temporary spacer, maintaining the height of the wrist and preventing the surrounding bones from crushing together while the area healed. The researchers wanted to see if this relatively simple technique could relieve pain and allow these patients to return to their daily lives and jobs without the need for more invasive procedures like fusing the entire wrist.
The study involved six individuals, mostly those who performed heavy physical labor such as construction or farming, all suffering from the advanced stage of the disease where the lunate had collapsed. The surgical process began with a small cut on the back of the wrist to access the damaged bone. Once the surgeon confirmed the bone was dead, they carefully removed it entirely, taking care to preserve the surrounding ligaments that hold the wrist together. To create the replacement, the surgeons made two small incisions on the palm side of the wrist to harvest the palmaris longus tendon, a thin strip of tissue that many people have running down the center of their forearm. They took both tendons, braided them together, and stitched them into a firm, round ball. This tendon ball was then sized to fit perfectly into the empty space left by the lunate and secured in place. Finally, the surgeon repaired the ligaments and closed the incisions, leaving the wrist immobilized in a cast for two weeks to allow the new structure to settle.
The results of this approach were encouraging over the short term. Every patient in the group healed well, with their incisions closing within two weeks and no signs of infection or tissue death. More importantly, all six patients reported that their pain disappeared and were able to return to their previous occupations within four weeks of the surgery. At an average follow-up of twelve months, the patients continued to use their wrists for daily tasks and work without the severe pain that had brought them to the hospital. The surgeons observed that the tendon ball successfully filled the void, providing enough support to keep the wrist functional. One patient in the group had also suffered a broken bone in the forearm at the same time, but even with this additional injury, the wrist procedure contributed to a full recovery of function.
While the outcomes were positive, the authors are careful to note the limits of their findings. Because the group was small and the follow-up period was relatively short, they cannot yet say for certain that this method will prevent the wrist from collapsing in the long run or that it will work for everyone. The study did not use complex scoring systems to measure grip strength or range of motion, relying instead on the patients' own reports of pain relief and their ability to work. The researchers suggest that this technique is a viable option for patients with this specific stage of the disease, offering a way to preserve movement when other options might be more drastic. They emphasize that larger studies with longer observation times are needed to confirm whether the tendon ball can serve as a permanent solution or if it is best viewed as a successful bridge to recovery in the early years after surgery.
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