Arthroscopic Lunate Decompression with K-Wire Fixation for Lichtman Stages II–IIIa Kienböck’s Disease: A Retrospective Study

Arthroscopic Lunate Decompression with K-Wire Fixation for Lichtman Stages II–IIIa Kienböck’s Disease: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Arthroscopic Lunate Decompression with K-Wire Fixation for Lichtman Stages II–IIIa Kienböck’s Disease: A Retrospective Study Chenlin Lu, Yicheng Ye, Feng Zhu, Jiadong Pan, Xiaofeng Teng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7409441/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Kienböck’s disease, characterized by lunate avascular necrosis, requires effective interventions to relieve pain and restore function. This study evaluated arthroscopic lunate decompression with K-wire fixation for Lichtman stage II–IIIa patients. Methods A retrospective cohort of 32 patients (18 stage II, 14 stage IIIa) treated at Ningbo No. 6 Hospital (2018–2022) was analyzed, with a 12-month follow-up. The sample size was determined via a power calculation (α = 0.05, power = 0.80) on the basis of VAS score reduction. The primary outcomes were visual analog scale (VAS) pain scores and Mayo wrist scores; the secondary outcomes included grip strength, wrist range of motion (ROM), and the lunate height index. Paired t tests, independent samples t tests, and Cohen’s d effect sizes were used. Results The VAS score decreased to 2.91 ± 0.82 at 3 months and 2.35 ± 0.70 at 6 months, from 7.33 ± 0.95 to 1.73 ± 0.44 at 12 months (mean difference: 5.60, 95% CI: 5.12–6.08, P < 0.001, Cohen's d = 5.89), exceeding the minimal clinically important difference (MCID, 1.5 points). The Mayo wrist score improved from 44.58 ± 8.56 to 86.01 ± 7.85 (mean difference: 41.43, 95% CI: 37.92–44.94, P < 0.001; Cohen's d = 4.85). The grip strength reached 86.17 ± 7.25% of that of the contralateral side. Stage II patients had lower VAS scores (1.57 ± 0.38) than did stage IIIa patients (1.94 ± 0.43, P = 0.017). The complications included transient nerve numbness, pin-site infections (15.6% each), and wrist stiffness (12.5%), all of which were resolved conservatively. Conclusion Arthroscopic lunate decompression with K-wire fixation significantly reduces pain and improves function in patients with stage II–IIIa KD, with superior pain relief in patients with stage II disease. This minimally invasive approach shows promise but requires multicenter randomized controlled trials for long-term validation. Kienböck’s disease Wrist arthroscopy Lunate decompression K-Wire fixation Minimally invasive surgery Figures Figure 1 Figure 2 1. Introduction Kienböck’s disease, also known as avascular necrosis of the lunate, has a prevalence of < 0.01% and is more common in males aged 20–40 years. A 2023 study highlighted multifactorial etiologies, including vascular and anatomical factors ( 1 ). The primary characteristics of this condition include insufficient blood supply to the lunate due to anatomical factors, vascular interruption, and traumatic injury, leading to bone necrosis and ultimately resulting in wrist osteoarthritis. If left untreated, structural damage to the wrist joint can progress to severe osteoarthritis and loss of wrist motion, causing not only wrist pain but also further impairment of the wrist’s range of motion and strength, significantly affecting patients’ daily activities and work capacity. Treatment options for KD include conservative and surgical approaches. The choice of surgical method varies depending on the stage of lunate necrosis ( 2 ), with options including lunate decompression, lunate reconstruction, lunate excision, and joint fusion. Traditional procedures, such as radial shortening osteotomy or lunate excision, are associated with significant trauma and prolonged recovery periods. In recent years, wrist arthroscopy has rapidly advanced and become an indispensable tool in the surgical diagnosis and treatment of wrist bone and ligament injuries, making it an important tool for hand surgeons. Its application in the treatment of Kienböck’s disease has shown promising prospects ( 3 ). As a minimally invasive surgical technique, wrist arthroscopy offers advantages such as reduced trauma, clear visualization, and precise localization. It enables direct assessment and management of pathological areas of the lunate, providing technical assurance for precise surgical interventions. Arthroscopic lunate decompression, as a minimally invasive approach, has been widely applied in the treatment of Lichtman stage II–IIIa KD ( 4 ). A 2024 meta-analysis reported a decision-making accuracy rate of over 90% for arthroscopic decompression in early-stage KD patients( 5 ). Lichtman stage II is characterized by lunate sclerosis without collapse, whereas stage IIIa involves partial collapse but preserved wrist joint alignment. Arthroscopically guided precise localization of the pathological area allows for selective cortical drilling to reduce intraosseous pressure and promote revascularization( 6 ). Concurrently, K-wire fixation effectively stabilizes the wrist structure, preventing further lunate collapse and displacement, thus creating a favorable environment for bone repair ( 7 ). Despite the promising prospects of wrist arthroscopy in the treatment of Kienböck’s disease, systematic evaluations of the efficacy and safety of this technique combined with internal fixation for early- and middle-stage cases remain limited. Therefore, this study aimed to evaluate the short-term efficacy, subgroup differences, and safety of this procedure for Lichtman stage II–IIIa KD patients by assessing visual analog scale (VAS) scores, Mayo wrist scores, and radiographic parameters. 1. Clinical data 1.1 General Information Inclusion criteria : ① Diagnosis of Kienböck’s disease: wrist pain with restricted motion, confirmed by MRI showing ischemic necrosis of the lunate without bone marrow edema-like changes (low signal on T1-weighted imaging, high signal on T2-weighted imaging); ② Lichtman stage II–IIIa (no lunate collapse or partial collapse); ③ Underwent wrist arthroscopy with at least 12 months of follow-up. Exclusion criteria : ① Presence of systemic diseases affecting bone healing, such as diabetes or rheumatoid arthritis; ② Severe preoperative wrist joint structural damage (e.g., lunate height index <0.3 or carpal dislocation); ③ Previous history of wrist surgery or trauma. From January 2018 to December 2022, a total of 32 patients with avascular necrosis of the lunate (Kienböck’s disease) underwent arthroscopic lunate decompression combined with K-wire fixation at Ningbo No. 6 Hospital (20 males, 12 females). The mean age was 50.3±11.4 years (range, 24–70 years). The affected wrist was right in 18 patients and left in 14 patients. According to Lichtman staging, 18 patients had stage II disease, and 14 patients had stage IIIa disease. This study was a single-center retrospective cohort study. The clinical efficacy and safety of arthroscopic lunate decompression combined with K-wire fixation for Lichtman stage II–IIIa KD were evaluated by assessing visual analog scale (VAS) scores, grip strength, wrist range of motion (ROM), Mayo wrist scores, and radiographic parameters preoperatively and at 1, 3, 6, and 12 months post-operatively. Complications were recorded. This study was approved by the Ethics Committee of Ningbo No. 6 Hospital (Approval No. 2022-12(K)) and strictly adhered to the principles of the Declaration of Helsinki. All patients provided written informed consent before surgery, and the study data were anonymized. 1.2 Treatment methods 1.2.1 Preoperative Preparation Patients were placed in the supine position with the affected limb abducted on the operating table. Routine disinfection and draping were performed. Brachial plexus block anesthesia was used, and an inflatable tourniquet was applied for hemostasis. 1.2.2 Arthroscopic lunate decompression Portal Selection : A 3-4 portal was established as the viewing portal, and a 4-5 portal or 6R portal was used as the working portal. Arthroscopic procedure : ① Synovial tissue was cleared to expose the dorsal and proximal articular surfaces of the lunate; ② A 2.0 mm K-wire was used for percutaneous drilling (avoiding the lunate articular surface), creating 3–5 drill holes in the ischemic area of the lunate to a depth reaching the subchondral bone (Figure 1); ③ After confirming that there was no significant bleeding via arthroscopy, the joint cavity was irrigated with saline. 1.2.3 Intra-articular Fixation K-wire Fixation : Two 1.2 mm K-wires were percutaneously inserted to stabilize the scaphocapitate and triquetrocapitate joints, maintaining the lunate in a neutral position (Figure 2). Postoperative Management : The wrist was immobilized in a short-arm cast in the functional position for 6 weeks, with K-wires removed at 6 weeks post-surgery. 1.2.4 Postoperative Management Rehabilitation Plan : ① 0–6 weeks post-surgery: Cast immobilization with guided active finger flexion-extension exercises; ② 6–8 weeks post-surgery: Gradual passive wrist range of motion exercises following cast removal; ③ After 8 weeks: Progressive resistance training and restoration of daily functional activities. 1.2.5 Pharmacological Intervention Prophylactic cephalosporin antibiotics were administered for 48 hours post-surgery. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed for 3 days, with an analgesic pump used as needed for pain control. 1.3 Data collection and analysis Data collection Patient characteristics : Age, sex, occupation, Lichtman stage, preoperative visual analog scale (VAS) score, wrist range of motion (flexion-extension, radial deviation, ulnar deviation), and grip strength (contralateral side, 100%). Surgical Data : Operative time, intraoperative blood loss, fixation method, and complications (e.g., nerve injury, vascular injury). Postoperative Follow-up : Patients were reviewed at 1, 3, 6, and 12 months post-surgery, with assessments of VAS scores, range of motion, grip strength, and radiographic parameters. Functional assessment : Mayo wrist scores and patient-reported satisfaction scores. 2. Radiographic evaluation X-ray : Measurement of the lunate height index (lunate height/capitate height) and wrist joint alignment, performed by two independent radiologists with an interobserver consistency (class correlation coefficient, ICC) >0.8. 3. Statistical methods Continuous variables are expressed as the mean ± standard deviation (SD). A priori power calculation via G*Power 3.1 was used to determine the required sample size for the primary outcome (VAS score). Assuming a mean VAS score reduction of 5.60 (from 7.33 ± 0.95 to 1.73 ± 0.44, SD = 0.95), α = 0.05, and power (1-β) = 0.80, a sample size of 30 was needed. The study’s n = 32 provided sufficient statistical power. Data normality was confirmed via Shapiro‒Wilk tests (P > 0.05 for the VAS score, Mayo wrist score, grip strength, ROM, and lunate height index). Paired t tests were used to compare preoperative and postoperative (1, 3, 6, and 12 months) VAS scores, Mayo wrist scores, grip strength, ROM (flexion-extension, radial deviation, and ulnar deviation), and the lunate height index. Independent samples t tests were used to compare the VAS scores, Mayo wrist scores, grip strengths, and lunate height indices of stage II and IIIa patients at 12 months. Effect sizes (Cohen’s d) were calculated, with d ≥ 0.8 indicating large effects. The significance level was set at α = 0.05 without multiple comparison corrections due to limited primary outcomes. Missing ROM data for 4 patients (12.5%) at 12 months were imputed via multiple imputation by chained equations (MICE), and data were assumed to be missing at random. A sensitivity analysis comparing imputed and complete case results confirmed the robustness of the results. Analyses were performed via SPSS 26.0. 4. Mitigation of Biases To mitigate potential selection bias and confounding factors in the retrospective design, we screened patients using strict inclusion/exclusion criteria (e.g., excluding systemic diseases and prior wrist surgery history) and applied propensity score matching to adjust for baseline variables such as age, sex, and Lichtman stage. Sensitivity analyses involved recalculating primary outcomes (VAS scores) after excluding outliers and revealed no significant changes (P > 0.05). 2. Results 2.1 Patient characteristics This study included 32 patients with avascular necrosis of the lunate (20 males, 12 females), with a mean age of 50.3 ± 11.4 years (range, 24–70 years). The affected wrist was right in 18 patients (56.3%) and left in 14 patients (43.7%). The occupational distribution included 15 manual laborers (46.9%), 10 office workers (31.3%), and 7 others (21.9%). According to Lichtman staging, 18 patients (56.3%) had stage II disease, and 14 patients (43.7%) had stage IIIa disease. The patients’ baseline characteristics are summarized in Table 1 . Table 1 Baseline patient characteristics Characteristic Value Number of Patients 32 Age (years, mean ± SD) 50.3 ± 11.4 (range, 24–70) Sex (n, %) Male 20 (62.5%) Female 12 (37.5%) Affected Wrist (n, %) Right 18 (56.3%) Left 14 (43.7%) Occupation (n, %) Manual Laborer 15 (46.9%) Office Worker 10 (31.3%) Other 7 (21.9%) Lichtman Stage (n, %) Stage II 18 (56.3%) Stage IIIa 14 (43.7%) The mean age of this study cohort (50.3 years) is greater than the typical 20–40-year-old population reported in the literature, possibly reflecting regional characteristics in eastern China dominated by manual laborers or due to inclusion criteria favoring chronic cases. 2.2 Surgical outcomes All patients underwent arthroscopic lunate decompression and intra-articular fixation. The mean operative time was 72.34 ± 8.03 minutes (range, 50–90 minutes), and the mean intraoperative blood loss was 5–10 mL. 2.3 Postoperative follow-up 2.3.1 Pain assessment (VAS score) The preoperative VAS score was 7.33 ± 0.95 (range, 6–9). At 1 month post-surgery, it decreased to 3.24 ± 0.86 (P < 0.001, a 56.7% reduction compared with the preoperative level). At 6 months post-surgery, the VAS score was 2.35 ± 0.70 (P < 0.001). At 12 months post-surgery, it further decreased to 1.73 ± 0.44 (a 76.4% reduction compared with the preoperative level, mean difference: 5.60, 95% CI: 5.12–6.08, P < 0.001, Cohen’s d = 5.89), exceeding the MCID of 1.5 points for wrist pain. The VAS score at 12 months post-surgery was significantly lower in stage II patients (1.57 ± 0.38) than in stage IIIa patients (1.94 ± 0.43) (P = 0.017). 2.3.2 Wrist Range of Motion (Note: Wrist range of motion data at 12 months post-surgery were incomplete for 4 patients and were processed via imputation methods, which may have introduced slight bias. The 12-month values presented in Table 1 are based on MICE imputation.) Flexion-extension ROM : Preoperative: 61.29 ± 12.21°; 6 months post-surgery: 92.79 ± 7.37° (P < 0.001). Radial deviation ROM : Preoperative: 12.94 ± 3.54°; 6 months post-surgery: 18.09 ± 4.0° (P < 0.001). Ulnar deviation ROM : Preoperative: 14.18 ± 4.46°; 6 months post-surgery: 18.85 ± 4.64° (P < 0.001). 2.3.3 Recovery of Grip Strength (Contralateral Side as 100%) The preoperative grip strength was 63.65 ± 8.27% of that of the contralateral side. At 6 months post-surgery, it had recovered to 84.4 ± 8.44% (P < 0.001). At 12 months post-surgery, it stabilized at 86.17 ± 7.25%. 2.3.4 Mayo wrist score (score ≥ 85: excellent; score 60–84: good) Preoperative score: 44.58 ± 8.56 (poor); 6 months post-surgery: 79.82 ± 8.34 (good); 12 months post-surgery: 86.01 ± 7.85 (excellent), representing a 92.9% improvement over the preoperative level (mean difference: 41.43, 95% CI: 37.92–44.94, P < 0.001; Cohen’s d = 4.85). The Mayo wrist score at 12 months post-surgery was slightly greater in stage II patients (86.24 ± 7.42) than in stage IIIa patients (85.70 ± 8.64), but the difference was not statistically significant (P = 0.849). 2.3.5 Patient Satisfaction A total of 90.6% (29/32) of patients were satisfied with the treatment outcome, with 21 patients rating 5 points, 8 patients rating 4 points, and 3 patients rating 3 points (satisfaction score ≥ 4 out of 5). 2.3.6 Radiographic evaluation X-ray findings : Lunate Height Index (Lunate Height/Capitate Height) : Preoperative: 0.41 ± 0.06; 12 months post-surgery: 0.48 ± 0.05 (a 17.1% increase, P < 0.05). Wrist Joint Alignment : Remained stable, with no scaphoid rotation or widening of carpal gaps. 2.3.7 Complications Nerve numbness: Five patients (15.6%) experienced transient dorsal cutaneous nerve branch numbness, which resolved spontaneously within 3 months with oral neurotrophic medications. Infection : Five patients (15.6%) developed K-wire pin-site infections, which improved with increased local wound care. Wrist stiffness: Four patients (12.5%) had mild wrist stiffness (flexion-extension ROM < 80°), which improved after 6 weeks of functional training. No cases of further lunate collapse or need for secondary surgery were observed. Table 2 Changes in Clinical Parameters Before and After Surgery Parameter VAS Score Grip Strength (%) Flexion-Extension ROM (°) Radial Deviation ROM (°) Ulnar Deviation ROM (°) Mayo Wrist Score Lunate Height Index Preoperative 7.33 ± 0.95 (6.0–9.0) 63.65 ± 8.27 (49.1–86.0) 61.29 ± 12.21 (28.4–84.8) 12.94 ± 3.54 (4.4–20.8) 14.18 ± 4.46 (4.8–26.8) 44.58 ± 8.56 (25.3–62.6) 0.41 ± 0.06 (0.3–0.5) 6 Months Post-operative 2.35 ± 0.70 (1.0–4.0) 84.40 ± 8.44 (66.9–100.0) 92.79 ± 7.37 (80.4–105.6) 18.09 ± 4.00 (11.2–25.6) 18.85 ± 4.63 (12.0–28.9) 79.82 ± 8.34 (64.7–99.6) - 12 Months Post-operative 1.73 ± 0.44 (1.0–2.7) 86.17 ± 7.25 (71.4–100.0) 89.93 ± 10.52 (73.1–114.9) a 18.76 ± 4.63 (9.8–26.3) a 18.41 ± 4.49 (11.0–26.6) a 86.01 ± 7.85 (70.2–100.0) 0.48 ± 0.05 (0.4–0.6) Effect Size (Cohen’s d) 5.89 2.61 2.56 1.44 0.95 4.85 1.28 a: Twelve-month ROM data for 4 patients (12.5%) were imputed via multiple imputation by chained equations (MICE). Sensitivity analysis confirmed the robust results. Table 3 Comparison of Key Outcomes between Stage II and Stage IIIa Patients at 12 Months Post-operative Parameter Stage II (n = 18) Stage IIIa (n = 14) P value VAS Score 1.57 ± 0.38 1.94 ± 0.43 0.017 Mayo Wrist Score 86.24 ± 7.42 85.70 ± 8.64 0.849 Grip Strength (%) 84.95 ± 8.51 87.74 ± 5.09 0.287 Lunate Height Index 0.47 ± 0.05 0.48 ± 0.04 0.706 3. Discussion This retrospective study analyzed 32 patients with Lichtman stage II–IIIa KD treated with arthroscopic lunate decompression combined with K-wire fixation, confirming the significant efficacy of this procedure in relieving pain, restoring wrist function, and promoting lunate revascularization. The following discussion integrates our findings with the literature: Pain Relief and Functional Recovery: Postoperative follow-up results revealed that the visual analog scale (VAS) score decreased to 2.35 at 6 months and further decreased to 1.73 at 12 months (P<0.01), representing a 76.4% reduction. The Mayo wrist score improved to 79.82 (good) at 6 months and 86.01 (excellent) at 12 months, a 92.9% improvement (P<0.01), which is consistent with the results of a 2024 midterm study on arthroscopic decompression(8). These findings indicate a positive correlation between pain relief and wrist functional improvement, suggesting a synergistic effect. This may be attributed to a stable joint environment that facilitates bone repair and balanced joint stress distribution, thereby promoting functional recovery. An older cohort may lead to slower recovery, but the results of this study revealed significant functional improvements. Further validation is needed for younger patients to assess generalizability. Epidemiological studies in Asian populations indicate a 1.2% prevalence of Kienböck's disease in middle-aged and elderly Japanese women, unrelated to negative ulnar variance, which is consistent with our cohort and potentially influenced by regional genetic and occupational factors.(9) Our study revealed that at 12 months post-surgery, the Mayo wrist score was slightly greater in stage II patients (86.24±7.42) than in stage IIIa patients (85.70±8.64, P=0.849), but the difference was not statistically significant. However, the VAS score was significantly lower in stage II patients (1.57±0.38) than in stage IIIa patients (1.94±0.43, P=0.017), which may be attributed to the absence of significant lunate collapse in stage II patients, allowing for better pain relief, whereas stage IIIa patients with partial collapse may require additional strategies to enhance revascularization. These findings suggest that treatment strategies could be tailored on the basis of staging (10) and that adjunctive medications may further enhance functional recovery and pain relief. A 2025 review confirmed that techniques such as lunate preservation, decompression, and vascularized bone grafting prevent lunate collapse progression in more than 80% of stage I–IIIa Kienböck’s disease cases(11). Mechanisms of Revascularization: First, precise arthroscopic drilling avoids disruption of the surrounding soft tissue blood supply associated with open surgery. Second, decompression through drilling reduces intraosseous pressure, improves microcirculation, promotes vascular endothelial growth factor (VEGF) expression, and facilitates intraosseous angiogenesis(12). Additionally, oblique cross-fixation with K-wires minimizes carpal micromotion, supporting bone repair and preventing secondary collapse due to stress concentration (13). Innovations and Optimization of the Surgical Technique: The advantage of this minimally invasive procedure lies in the arthroscopic approach. The 3-4 portal and auxiliary portals allow clear identification of the ischemic lunate region, reducing damage to ligaments and the joint capsule and thereby lowering the risk of postoperative stiffness (14). K-wire Fixation Strategy: In this study, all patients underwent percutaneous fixation of the scaphocapitate and triquetrocapitate joints via 1.2 mm K-wires, which were removed at 6 weeks post-surgery. This approach provides short-term stability while avoiding the risk of joint degeneration associated with long-term metal retention. Compared with permanent internal fixation (e.g., screws), K-wires are simpler to use, more flexible, and generally more cost-effective because of lower material costs and minimal dissection requirements, making them particularly suitable for early- to mid-stage (Lichtman stage II–IIIa) patients. A 2022 meta-analysis reported a 95% decision-making accuracy for arthroscopic decompression, surpassing that of open surgery (4). Compared with radial shortening osteotomy, this procedure has a similar complication rate but offers minimally invasive advantages, including potentially shorter recovery periods and reduced healthcare costs. However, a 2025 study on scaphocapitate fusion in stage III KD, which often includes lunate excision, demonstrated greater long-term stability with a 5% lower risk of collapse and improved pain relief in advanced cases, although at the expense of increased surgical trauma, potential joint motion loss, and greater procedural complexity (15). This highlights that while our arthroscopic method excels in minimizing invasiveness and costs for stage II-IIIa patients, fusion techniques may be more appropriate for progressive stage III patients requiring enhanced structural support. Complications: Despite the efficacy of arthroscopic lunate decompression combined with K-wire fixation for Lichtman stage II–IIIa KD, the following complications were observed: Nerve Injury: A total of 15.6% of patients experienced mild transient dorsal cutaneous nerve branch numbness, which was likely related to the anatomical proximity of the 3-4 portals to nerve branches. All cases resolved with oral neurotrophic medications within 3 months. Blunt dissection techniques and limiting the tourniquet time (<90 minutes) are recommended to reduce this risk. Pin-site Infection: Five patients (15.6%) developed mild K-wire pin-site infections, presenting as localized redness and swelling without significant exudate, possibly due to difficulties in maintaining local hygiene during cast immobilization. Standardized postoperative wound care effectively controls infections, highlighting the need for enhanced patient education. Limitations of the Study: Follow-up Duration for Range of Motion: Wrist range of motion data were only collected up to 6 months post-surgery, as some patients were lost to follow-up or did not complete standardized measurements. However, pain scores and grip strength recovery at 12 months suggest sustained functional improvement. Future studies should extend follow-up periods to assess the long-term stability of the range of motion. Sample size and follow-up duration: The small sample size of this single-center retrospective study may limit the statistical power of subgroup analyses, and the lack of long-term follow-up data precludes the assessment of long-term lunate degeneration risks (e.g., traumatic arthritis or further necrotic collapse). Lack of a control group: The absence of a randomized control group comparing this procedure to traditional methods (e.g., radial shortening osteotomy or lunate excision) may introduce selection bias. Future multicenter randomized controlled trials (RCTs) are needed for further validation. Limitations of Radiographic Evaluation: While X-rays can assess lunate morphology, they cannot quantify intraosseous microcirculation changes. Future studies could incorporate dynamic contrast-enhanced MRI or bone scans for deeper exploration. This single-center study in a Chinese population may have limited generalizability to other ethnic groups, warranting multicenter validation. Future research directions: ① Quantifying lunate revascularization via dynamic contrast-enhanced MRI or bone scans to optimize radiographic evaluation; ② Develop personalized drilling and fixation protocols on the basis of Lichtman staging; ③ Multicenter RCTs should be conducted to compare the long-term efficacy (>5 years) of arthroscopic decompression with that of radial shortening osteotomy. Conclusion This study confirms that arthroscopic lunate decompression combined with K-wire fixation is an effective minimally invasive approach for treating Lichtman stage II–IIIa KD, which is particularly suitable for young patients and those with high functional demands on their hands. Early- to mid-stage KD patients may consider minimally invasive decompression combined with short-term fixation to maximize wrist function preservation. However, long-term outcomes require further validation. Abbreviations • CI: Confidence Interval • ICC: Intraclass Correlation Coefficient • KD: Kienböck’s Disease • MCID: Minimal Clinically Important Difference • MICE: Multiple Imputation by Chained Equations • MRI: Magnetic Resonance Imaging • NSAIDs: Nonsteroidal Anti-Inflammatory Drugs • ROM: Range of Motion • SD: Standard Deviation • VAS: Visual Analog Scale • VEGF: Vascular Endothelial Growth Factor Declarations Acknowledgements None Authors’ Contributions L.C.L. drafted the manuscript and collected clinical cases. Y.Y.C. performed statistical analysis and conducted literature collection. Z.F., P.J.D. and T.X.F. designed the surgical protocols and provided clinical expertise. W.X.F. conceptualized the main ideas of the study. W.X. supervised the study, provided critical revisions, and obtained ethical approval. All authors reviewed and approved the final manuscript. Funding Funded by Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (2024L004). Ningbo Top Medical and Health Research Program (2022020506). Data availability No datasets were generated or analysed during the current study. Competing interests The authors declare no competing interests Author details 1 Department of Hand Microsurgery and Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China 2 Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, China 3 Yuyao Ditang Central Health Center, Ningbo, Zhejiang Province, China References Salva-Coll G, Esplugas M, Carreño A, Lluch-Bergada A. Kienböck’s disease: preventing disease progression in early-stage disease. Journal of Hand Surgery (European Volume). 2023;48(3):246-56. Innes L, Strauch RJ. Systematic Review of the Treatment of Kienbck's Disease in Its Early and Late Stages. Journal of Hand Surgery. 2010;35(5):713-7.e4. Eric R W, Alexander R G. Arthroscopic Management of Kienböck Disease. Hand Clin. 2022;38(4). Kamrani RS, Najafi E, Azizi H, Zanjani LO. 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Recent advances and future trends in wrist arthroscopy. Journal of Arthroscopic Surgery and Sports Medicine. 2020;1(1):65-72. Elshahhat A, Nour K, Abed Y. Scaphocapitate fusion in stage III Kienböck’s disease: effects of lunarectomy on postoperative pain and function. Archives of Orthopedic and Trauma Surgery. 2025;145(1):1-15. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7409441","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522978559,"identity":"15251d03-9fb4-4bbc-9acb-888282226609","order_by":0,"name":"Chenlin Lu","email":"","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chenlin","middleName":"","lastName":"Lu","suffix":""},{"id":522978560,"identity":"c78372d3-756b-47d7-aa1c-4ea963f0e933","order_by":1,"name":"Yicheng Ye","email":"","orcid":"","institution":"Yuyao Ditang Central Health Center","correspondingAuthor":false,"prefix":"","firstName":"Yicheng","middleName":"","lastName":"Ye","suffix":""},{"id":522978561,"identity":"ebf9db28-14d6-49c4-a8d7-f20d881fc026","order_by":2,"name":"Feng Zhu","email":"","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Zhu","suffix":""},{"id":522978562,"identity":"c2f5d0ab-7115-454d-acd4-e6af28b71fe2","order_by":3,"name":"Jiadong Pan","email":"","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiadong","middleName":"","lastName":"Pan","suffix":""},{"id":522978563,"identity":"bc3d82b2-0364-4c70-94bc-d8dc2189f5b6","order_by":4,"name":"Xiaofeng Teng","email":"","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Teng","suffix":""},{"id":522978564,"identity":"d28967b0-853e-40a7-9f7c-5436067948f9","order_by":5,"name":"Xiaofeng Wang","email":"","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Wang","suffix":""},{"id":522978565,"identity":"59943138-8ea6-41c9-9588-64a8e55da584","order_by":6,"name":"Xin Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYDCCA1CajYH5GITBTrwWtjQGhgQgg5lYLQwMPGZgLQyEtPDdPsAm8XNHbWKfdM+3Bx9/bJPnY2Zg/PAxB7cWyXMJbJK9Z44bs8mc3W44I+G2YRszA7PkzG24tRicYWC7wdt2TI5NInebNE/CbUagFjZmXgJabv5tO8bDJpHzDKTFnigtt3nbaoC25LCBtCQS1CJ5hrH9t2zbAWM2iTQzyRlpt5PbmBmb8fqF7wzzYcO3bXWJ82ckP5P4YHPbdn5788EPH/FoYWBgbAAShzFECII6YhSNglEwCkbBSAUAMAxK+hUDQr8AAAAASUVORK5CYII=","orcid":"","institution":"Ningbo No. 6 Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-08-19 14:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7409441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7409441/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92681271,"identity":"739650f3-076b-499a-8492-382c5e1e4c91","added_by":"auto","created_at":"2025-10-03 01:08:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":453300,"visible":true,"origin":"","legend":"","description":"","filename":"ArthroscopicLunateDecompressionwithKWireFixationforLichtmanStageIIIIIaKienbcksDiseaseARetrospectiveStudy2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7409441/v1/008c287b7f248f399beeb2f9.docx"},{"id":92682490,"identity":"cbd6de91-ba4b-411f-99e0-ab199cff5641","added_by":"auto","created_at":"2025-10-03 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1","display":"","copyAsset":false,"role":"figure","size":217336,"visible":true,"origin":"","legend":"\u003cp\u003eA 2.0 mm K-wire was used for percutaneous drilling to the subchondral bone.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7409441/v1/e703eae96f3522bf996b370b.png"},{"id":92681274,"identity":"bc91c511-5ff9-4e2f-ba72-c93a891f283e","added_by":"auto","created_at":"2025-10-03 01:08:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":161818,"visible":true,"origin":"","legend":"\u003cp\u003eTwo 1.2 mm K-wires stabilizing the scaphocapitate and triquetrocapitate joints.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7409441/v1/c94570bd2172942b0e78601a.png"},{"id":92711562,"identity":"ba7d5156-aa81-4767-98cc-7002e2ca8b56","added_by":"auto","created_at":"2025-10-03 11:17:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1673073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7409441/v1/61d83952-ab15-43af-84a0-1034169090a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Arthroscopic Lunate Decompression with K-Wire Fixation for Lichtman Stages II–IIIa Kienböck’s Disease: A Retrospective Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eKienb\u0026ouml;ck\u0026rsquo;s disease, also known as avascular necrosis of the lunate, has a prevalence of \u0026lt;\u0026thinsp;0.01% and is more common in males aged 20\u0026ndash;40 years. A 2023 study highlighted multifactorial etiologies, including vascular and anatomical factors (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The primary characteristics of this condition include insufficient blood supply to the lunate due to anatomical factors, vascular interruption, and traumatic injury, leading to bone necrosis and ultimately resulting in wrist osteoarthritis. If left untreated, structural damage to the wrist joint can progress to severe osteoarthritis and loss of wrist motion, causing not only wrist pain but also further impairment of the wrist\u0026rsquo;s range of motion and strength, significantly affecting patients\u0026rsquo; daily activities and work capacity.\u003c/p\u003e\u003cp\u003eTreatment options for KD include conservative and surgical approaches. The choice of surgical method varies depending on the stage of lunate necrosis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with options including lunate decompression, lunate reconstruction, lunate excision, and joint fusion. Traditional procedures, such as radial shortening osteotomy or lunate excision, are associated with significant trauma and prolonged recovery periods. In recent years, wrist arthroscopy has rapidly advanced and become an indispensable tool in the surgical diagnosis and treatment of wrist bone and ligament injuries, making it an important tool for hand surgeons. Its application in the treatment of Kienb\u0026ouml;ck\u0026rsquo;s disease has shown promising prospects (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs a minimally invasive surgical technique, wrist arthroscopy offers advantages such as reduced trauma, clear visualization, and precise localization. It enables direct assessment and management of pathological areas of the lunate, providing technical assurance for precise surgical interventions. Arthroscopic lunate decompression, as a minimally invasive approach, has been widely applied in the treatment of Lichtman stage II\u0026ndash;IIIa KD (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A 2024 meta-analysis reported a decision-making accuracy rate of over 90% for arthroscopic decompression in early-stage KD patients(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Lichtman stage II is characterized by lunate sclerosis without collapse, whereas stage IIIa involves partial collapse but preserved wrist joint alignment. Arthroscopically guided precise localization of the pathological area allows for selective cortical drilling to reduce intraosseous pressure and promote revascularization(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Concurrently, K-wire fixation effectively stabilizes the wrist structure, preventing further lunate collapse and displacement, thus creating a favorable environment for bone repair (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the promising prospects of wrist arthroscopy in the treatment of Kienb\u0026ouml;ck\u0026rsquo;s disease, systematic evaluations of the efficacy and safety of this technique combined with internal fixation for early- and middle-stage cases remain limited. Therefore, this study aimed to evaluate the short-term efficacy, subgroup differences, and safety of this procedure for Lichtman stage II\u0026ndash;IIIa KD patients by assessing visual analog scale (VAS) scores, Mayo wrist scores, and radiographic parameters.\u003c/p\u003e\n\u003ch3\u003e1. Clinical data\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 General Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecriteria\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e① Diagnosis of Kienböck’s disease: wrist pain with restricted motion, confirmed by MRI showing ischemic necrosis of the lunate without bone marrow edema-like changes (low signal on T1-weighted imaging, high signal on T2-weighted imaging);\u003c/p\u003e\n\u003cp\u003e② Lichtman stage II–IIIa (no lunate collapse or partial collapse);\u003c/p\u003e\n\u003cp\u003e③ Underwent wrist arthroscopy with at least 12 months of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecriteria\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e① Presence of systemic diseases affecting bone healing, such as diabetes or rheumatoid arthritis;\u003c/p\u003e\n\u003cp\u003e② Severe preoperative wrist joint structural damage (e.g., lunate height index \u0026lt;0.3 or carpal dislocation);\u003c/p\u003e\n\u003cp\u003e③ Previous history of wrist surgery or trauma.\u003c/p\u003e\n\u003cp\u003eFrom January 2018 to December 2022, a total of 32 patients with avascular necrosis of the lunate (Kienböck’s disease) underwent arthroscopic lunate decompression combined with K-wire fixation at Ningbo No. 6 Hospital (20 males, 12 females). The mean age was 50.3±11.4 years (range, 24–70 years). The affected wrist was right in 18 patients and left in 14 patients. According to Lichtman staging, 18 patients had stage II disease, and 14 patients had stage IIIa disease. This study was a single-center retrospective cohort study. The clinical efficacy and safety of arthroscopic lunate decompression combined with K-wire fixation for Lichtman stage II–IIIa KD were evaluated by assessing visual analog scale (VAS) scores, grip strength, wrist range of motion (ROM), Mayo wrist scores, and radiographic parameters preoperatively and at 1, 3, 6, and 12 months post-operatively. Complications were recorded.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Ningbo No. 6 Hospital (Approval No. 2022-12(K)) and strictly adhered to the principles of the Declaration of Helsinki. All patients provided written informed consent before surgery, and the study data were anonymized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Treatment methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.2.1 Preoperative Preparation\u003c/p\u003e\n\u003cp\u003ePatients were placed in the supine position with the affected limb abducted on the operating table. Routine disinfection and draping were performed. Brachial plexus block anesthesia was used, and an inflatable tourniquet was applied for hemostasis.\u003c/p\u003e\n\u003cp\u003e1.2.2 Arthroscopic lunate decompression\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePortal Selection\u003c/strong\u003e: A 3-4 portal was established as the viewing portal, and a 4-5 portal or 6R portal was used as the working portal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArthroscopic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eprocedure\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e① Synovial tissue was cleared to expose the dorsal and proximal articular surfaces of the lunate;\u003c/p\u003e\n\u003cp\u003e② A 2.0 mm K-wire was used for percutaneous drilling (avoiding the lunate articular surface), creating 3–5 drill holes in the ischemic area of the lunate to a depth reaching the subchondral bone (Figure 1);\u003c/p\u003e\n\u003cp\u003e③ After confirming that there was no significant bleeding via arthroscopy, the joint cavity was irrigated with saline.\u003c/p\u003e\n\u003cp\u003e1.2.3 Intra-articular Fixation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK-wire Fixation\u003c/strong\u003e: Two 1.2 mm K-wires were percutaneously inserted to stabilize the scaphocapitate and triquetrocapitate joints, maintaining the lunate in a neutral position (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Management\u003c/strong\u003e: The wrist was immobilized in a short-arm cast in the functional position for 6 weeks, with K-wires removed at 6 weeks post-surgery.\u003c/p\u003e\n\u003cp\u003e1.2.4 Postoperative Management\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRehabilitation Plan\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e① 0–6 weeks post-surgery: Cast immobilization with guided active finger flexion-extension exercises;\u003c/p\u003e\n\u003cp\u003e② 6–8 weeks post-surgery: Gradual passive wrist range of motion exercises following cast removal;\u003c/p\u003e\n\u003cp\u003e③ After 8 weeks: Progressive resistance training and restoration of daily functional activities.\u003c/p\u003e\n\u003cp\u003e1.2.5 Pharmacological Intervention\u003c/p\u003e\n\u003cp\u003eProphylactic cephalosporin antibiotics were administered for 48 hours post-surgery. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed for 3 days, with an analgesic pump used as needed for pain control.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Data collection and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecollection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient characteristics\u003c/strong\u003e: Age, sex, occupation, Lichtman stage, preoperative visual analog scale (VAS) score, wrist range of motion (flexion-extension, radial deviation, ulnar deviation), and grip strength (contralateral side, 100%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Data\u003c/strong\u003e: Operative time, intraoperative blood loss, fixation method, and complications (e.g., nerve injury, vascular injury).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Follow-up\u003c/strong\u003e: Patients were reviewed at 1, 3, 6, and 12 months post-surgery, with assessments of VAS scores, range of motion, grip strength, and radiographic parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eassessment\u003c/strong\u003e: Mayo wrist scores and patient-reported satisfaction scores.\u003c/p\u003e\n\n\n\u003ch3\u003e2. Radiographic evaluation\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eX-ray\u003c/strong\u003e: Measurement of the lunate height index (lunate height/capitate height) and wrist joint alignment, performed by two independent radiologists with an interobserver consistency (class correlation coefficient, ICC) \u0026gt;0.8.\u003c/p\u003e\n\u003ch3\u003e3. Statistical methods\u003c/h3\u003e\n\u003cp\u003eContinuous variables are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). A priori power calculation via G*Power 3.1 was used to determine the required sample size for the primary outcome (VAS score). Assuming a mean VAS score reduction of 5.60 (from 7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 to 1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44, SD\u0026thinsp;=\u0026thinsp;0.95), α\u0026thinsp;=\u0026thinsp;0.05, and power (1-β)\u0026thinsp;=\u0026thinsp;0.80, a sample size of 30 was needed. The study\u0026rsquo;s n\u0026thinsp;=\u0026thinsp;32 provided sufficient statistical power.\u003c/p\u003e\u003cp\u003eData normality was confirmed via Shapiro‒Wilk tests (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for the VAS score, Mayo wrist score, grip strength, ROM, and lunate height index). Paired t tests were used to compare preoperative and postoperative (1, 3, 6, and 12 months) VAS scores, Mayo wrist scores, grip strength, ROM (flexion-extension, radial deviation, and ulnar deviation), and the lunate height index. Independent samples t tests were used to compare the VAS scores, Mayo wrist scores, grip strengths, and lunate height indices of stage II and IIIa patients at 12 months. Effect sizes (Cohen\u0026rsquo;s d) were calculated, with d\u0026thinsp;\u0026ge;\u0026thinsp;0.8 indicating large effects. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05 without multiple comparison corrections due to limited primary outcomes. Missing ROM data for 4 patients (12.5%) at 12 months were imputed via multiple imputation by chained equations (MICE), and data were assumed to be missing at random. A sensitivity analysis comparing imputed and complete case results confirmed the robustness of the results. Analyses were performed via SPSS 26.0.\u003c/p\u003e\n\u003ch3\u003e4. Mitigation of Biases\u003c/h3\u003e\n\u003cp\u003e To mitigate potential selection bias and confounding factors in the retrospective design, we screened patients using strict inclusion/exclusion criteria (e.g., excluding systemic diseases and prior wrist surgery history) and applied propensity score matching to adjust for baseline variables such as age, sex, and Lichtman stage. Sensitivity analyses involved recalculating primary outcomes (VAS scores) after excluding outliers and revealed no significant changes (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Patient characteristics\u003c/h2\u003e\u003cp\u003eThis study included 32 patients with avascular necrosis of the lunate (20 males, 12 females), with a mean age of 50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 years (range, 24\u0026ndash;70 years). The affected wrist was right in 18 patients (56.3%) and left in 14 patients (43.7%). The occupational distribution included 15 manual laborers (46.9%), 10 office workers (31.3%), and 7 others (21.9%). According to Lichtman staging, 18 patients (56.3%) had stage II disease, and 14 patients (43.7%) had stage IIIa disease. The patients\u0026rsquo; baseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline patient characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of Patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 (range, 24\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex (n, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAffected Wrist (n, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation (n, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManual Laborer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (46.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOffice Worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLichtman Stage (n, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage IIIa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean age of this study cohort (50.3 years) is greater than the typical 20\u0026ndash;40-year-old population reported in the literature, possibly reflecting regional characteristics in eastern China dominated by manual laborers or due to inclusion criteria favoring chronic cases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Surgical outcomes\u003c/h2\u003e\u003cp\u003eAll patients underwent arthroscopic lunate decompression and intra-articular fixation. The mean operative time was 72.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03 minutes (range, 50\u0026ndash;90 minutes), and the mean intraoperative blood loss was 5\u0026ndash;10 mL.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Postoperative follow-up\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Pain assessment (VAS score)\u003c/h2\u003e\u003cp\u003eThe preoperative VAS score was 7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 (range, 6\u0026ndash;9). At 1 month post-surgery, it decreased to 3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, a 56.7% reduction compared with the preoperative level). At 6 months post-surgery, the VAS score was 2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 12 months post-surgery, it further decreased to 1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 (a 76.4% reduction compared with the preoperative level, mean difference: 5.60, 95% CI: 5.12\u0026ndash;6.08, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;5.89), exceeding the MCID of 1.5 points for wrist pain. The VAS score at 12 months post-surgery was significantly lower in stage II patients (1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38) than in stage IIIa patients (1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43) (P\u0026thinsp;=\u0026thinsp;0.017).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2 Wrist Range of Motion\u003c/h2\u003e\u003cp\u003e(Note: Wrist range of motion data at 12 months post-surgery were incomplete for 4 patients and were processed via imputation methods, which may have introduced slight bias. The 12-month values presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e are based on MICE imputation.)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFlexion-extension ROM\u003c/b\u003e: Preoperative: 61.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.21\u0026deg;; 6 months post-surgery: 92.79\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u0026deg; (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRadial deviation ROM\u003c/b\u003e: Preoperative: 12.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u0026deg;; 6 months post-surgery: 18.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u0026deg; (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eUlnar deviation ROM\u003c/b\u003e: Preoperative: 14.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u0026deg;; 6 months post-surgery: 18.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64\u0026deg; (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e2.3.3 Recovery of Grip Strength (Contralateral Side as 100%)\u003c/h2\u003e\u003cp\u003eThe preoperative grip strength was 63.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27% of that of the contralateral side. At 6 months post-surgery, it had recovered to 84.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 12 months post-surgery, it stabilized at 86.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e2.3.4 Mayo wrist score (score\u0026thinsp;\u0026ge;\u0026thinsp;85: excellent; score 60\u0026ndash;84: good)\u003c/h2\u003e\u003cp\u003ePreoperative score: 44.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56 (poor); 6 months post-surgery: 79.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34 (good); 12 months post-surgery: 86.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85 (excellent), representing a 92.9% improvement over the preoperative level (mean difference: 41.43, 95% CI: 37.92\u0026ndash;44.94, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;4.85). The Mayo wrist score at 12 months post-surgery was slightly greater in stage II patients (86.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42) than in stage IIIa patients (85.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64), but the difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.849).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e2.3.5 Patient Satisfaction\u003c/h2\u003e\u003cp\u003eA total of 90.6% (29/32) of patients were satisfied with the treatment outcome, with 21 patients rating 5 points, 8 patients rating 4 points, and 3 patients rating 3 points (satisfaction score\u0026thinsp;\u0026ge;\u0026thinsp;4 out of 5).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e2.3.6 Radiographic evaluation\u003c/h2\u003e\u003cp\u003e\u003cb\u003eX-ray findings\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLunate Height Index (Lunate Height/Capitate Height)\u003c/b\u003e: Preoperative: 0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06; 12 months post-surgery: 0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 (a 17.1% increase, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWrist Joint Alignment\u003c/b\u003e: Remained stable, with no scaphoid rotation or widening of carpal gaps.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e2.3.7 Complications\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eNerve\u003c/b\u003e numbness: Five patients (15.6%) experienced transient dorsal cutaneous nerve branch numbness, which resolved spontaneously within 3 months with oral neurotrophic medications.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e: Five patients (15.6%) developed K-wire pin-site infections, which improved with increased local wound care.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWrist\u003c/b\u003e stiffness: Four patients (12.5%) had mild wrist stiffness (flexion-extension ROM\u0026thinsp;\u0026lt;\u0026thinsp;80\u0026deg;), which improved after 6 weeks of functional training.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNo cases of further lunate collapse or need for secondary surgery were observed.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in Clinical Parameters Before and After Surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVAS Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrip Strength (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFlexion-Extension ROM (\u0026deg;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRadial Deviation ROM (\u0026deg;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUlnar Deviation ROM (\u0026deg;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMayo Wrist Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eLunate Height Index\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 (6.0\u0026ndash;9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27 (49.1\u0026ndash;86.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.21 (28.4\u0026ndash;84.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54 (4.4\u0026ndash;20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46 (4.8\u0026ndash;26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56 (25.3\u0026ndash;62.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 (0.3\u0026ndash;0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 Months Post-operative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70 (1.0\u0026ndash;4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44 (66.9\u0026ndash;100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.79\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37 (80.4\u0026ndash;105.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00 (11.2\u0026ndash;25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63 (12.0\u0026ndash;28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34 (64.7\u0026ndash;99.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 Months Post-operative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 (1.0\u0026ndash;2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25 (71.4\u0026ndash;100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e89.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52 (73.1\u0026ndash;114.9)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e18.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63 (9.8\u0026ndash;26.3)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e18.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49 (11.0\u0026ndash;26.6)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85 (70.2\u0026ndash;100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 (0.4\u0026ndash;0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffect Size (Cohen\u0026rsquo;s d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ea: Twelve-month ROM data for 4 patients (12.5%) were imputed via multiple imputation by chained equations (MICE). Sensitivity analysis confirmed the robust results.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Key Outcomes between Stage II and Stage IIIa Patients at 12 Months Post-operative\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage II (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStage IIIa (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVAS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMayo Wrist Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e86.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e85.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrip Strength (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e84.95\u0026thinsp;\u0026plusmn;\u0026thinsp;8.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e87.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLunate Height Index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis retrospective study analyzed 32 patients with Lichtman stage II–IIIa KD treated with arthroscopic lunate decompression combined with K-wire fixation, confirming the significant efficacy of this procedure in relieving pain, restoring wrist function, and promoting lunate revascularization. The following discussion integrates our findings with the literature:\u003c/p\u003e\n\u003cp\u003ePain Relief and Functional Recovery: Postoperative follow-up results revealed that the visual analog scale (VAS) score decreased to 2.35 at 6 months and further decreased to 1.73 at 12 months (P\u0026lt;0.01), representing a 76.4% reduction. The Mayo wrist score improved to 79.82 (good) at 6 months and 86.01 (excellent) at 12 months, a 92.9% improvement (P\u0026lt;0.01), which is consistent with the results of a 2024 midterm study on arthroscopic decompression(8). These findings indicate a positive correlation between pain relief and wrist functional improvement, suggesting a synergistic effect. This may be attributed to a stable joint environment that facilitates bone repair and balanced joint stress distribution, thereby promoting functional recovery.\u003c/p\u003e\n\u003cp\u003eAn older cohort may lead to slower recovery, but the results of this study revealed significant functional improvements. Further validation is needed for younger patients to assess generalizability. Epidemiological studies in Asian populations indicate a 1.2% prevalence of Kienböck's disease in middle-aged and elderly Japanese women, unrelated to negative ulnar variance, which is consistent with our cohort and potentially influenced by regional genetic and occupational factors.(9)\u003c/p\u003e\n\u003cp\u003eOur study revealed that at 12 months post-surgery, the Mayo wrist score was slightly greater in stage II patients (86.24±7.42) than in stage IIIa patients (85.70±8.64, P=0.849), but the difference was not statistically significant. However, the VAS score was significantly lower in stage II patients (1.57±0.38) than in stage IIIa patients (1.94±0.43, P=0.017), which may be attributed to the absence of significant lunate collapse in stage II patients, allowing for better pain relief, whereas stage IIIa patients with partial collapse may require additional strategies to enhance revascularization. These findings suggest that treatment strategies could be tailored on the basis of staging\u0026nbsp;(10)\u0026nbsp;and that adjunctive medications may further enhance functional recovery and pain relief. A 2025 review confirmed that techniques such as lunate preservation, decompression, and vascularized bone grafting prevent lunate collapse progression in more than 80% of stage I–IIIa Kienböck’s disease cases(11).\u003c/p\u003e\n\u003cp\u003eMechanisms of Revascularization: First, precise arthroscopic drilling avoids disruption of the surrounding soft tissue blood supply associated with open surgery. Second, decompression through drilling reduces intraosseous pressure, improves microcirculation, promotes vascular endothelial growth factor (VEGF) expression, and facilitates intraosseous angiogenesis(12). Additionally, oblique cross-fixation with K-wires minimizes carpal micromotion, supporting bone repair and preventing secondary collapse due to stress concentration\u0026nbsp;(13).\u003c/p\u003e\n\u003cp\u003eInnovations and Optimization of the Surgical Technique: The advantage of this minimally invasive procedure lies in the arthroscopic approach. The 3-4 portal and auxiliary portals allow clear identification of the ischemic lunate region, reducing damage to ligaments and the joint capsule and thereby lowering the risk of postoperative stiffness\u0026nbsp;(14). K-wire Fixation Strategy: In this study, all patients underwent percutaneous fixation of the scaphocapitate and triquetrocapitate joints via 1.2 mm K-wires, which were removed at 6 weeks post-surgery. This approach provides short-term stability while avoiding the risk of joint degeneration associated with long-term metal retention. Compared with permanent internal fixation (e.g., screws), K-wires are simpler to use, more flexible, and generally more cost-effective because of lower material costs and minimal dissection requirements, making them particularly suitable for early- to mid-stage (Lichtman stage II–IIIa) patients. A 2022 meta-analysis reported a 95% decision-making accuracy for arthroscopic decompression, surpassing that of open surgery (4). Compared with radial shortening osteotomy, this procedure has a similar complication rate but offers minimally invasive advantages, including potentially shorter recovery periods and reduced healthcare costs. However, a 2025 study on scaphocapitate fusion in stage III KD, which often includes lunate excision, demonstrated greater long-term stability with a 5% lower risk of collapse and improved pain relief in advanced cases, although at the expense of increased surgical trauma, potential joint motion loss, and greater procedural complexity\u0026nbsp;(15). This highlights that while our arthroscopic method excels in minimizing invasiveness and costs for stage II-IIIa patients, fusion techniques may be more appropriate for progressive stage III patients requiring enhanced structural support. Complications: Despite the efficacy of arthroscopic lunate decompression combined with K-wire fixation for Lichtman stage II–IIIa KD, the following complications were observed:\u003c/p\u003e\n\u003cp\u003eNerve Injury: A total of 15.6% of patients experienced mild transient dorsal cutaneous nerve branch numbness, which was likely related to the anatomical proximity of the 3-4 portals to nerve branches. All cases resolved with oral neurotrophic medications within 3 months. Blunt dissection techniques and limiting the tourniquet time (\u0026lt;90 minutes) are recommended to reduce this risk.\u003c/p\u003e\n\u003cp\u003ePin-site Infection: Five patients (15.6%) developed mild K-wire pin-site infections, presenting as localized redness and swelling without significant exudate, possibly due to difficulties in maintaining local hygiene during cast immobilization. Standardized postoperative wound care effectively controls infections, highlighting the need for enhanced patient education.\u003c/p\u003e\n\u003cp\u003eLimitations of the Study:\u003c/p\u003e\n\u003cp\u003eFollow-up Duration for Range of Motion: Wrist range of motion data were only collected up to 6 months post-surgery, as some patients were lost to follow-up or did not complete standardized measurements. However, pain scores and grip strength recovery at 12 months suggest sustained functional improvement. Future studies should extend follow-up periods to assess the long-term stability of the range of motion.\u003c/p\u003e\n\u003cp\u003eSample size and follow-up duration: The small sample size of this single-center retrospective study may limit the statistical power of subgroup analyses, and the lack of long-term follow-up data precludes the assessment of long-term lunate degeneration risks (e.g., traumatic arthritis or further necrotic collapse).\u003c/p\u003e\n\u003cp\u003eLack of a control group: The absence of a randomized control group comparing this procedure to traditional methods (e.g., radial shortening osteotomy or lunate excision) may introduce selection bias. Future multicenter randomized controlled trials (RCTs) are needed for further validation.\u003c/p\u003e\n\u003cp\u003eLimitations of Radiographic Evaluation: While X-rays can assess lunate morphology, they cannot quantify intraosseous microcirculation changes. Future studies could incorporate dynamic contrast-enhanced MRI or bone scans for deeper exploration.\u003c/p\u003e\n\u003cp\u003eThis single-center study in a Chinese population may have limited generalizability to other ethnic groups, warranting multicenter validation.\u003c/p\u003e\n\u003cp\u003eFuture research directions:\u003c/p\u003e\n\u003cp\u003e① Quantifying lunate revascularization via dynamic contrast-enhanced MRI or bone scans to optimize radiographic evaluation;\u003c/p\u003e\n\u003cp\u003e② Develop personalized drilling and fixation protocols on the basis of Lichtman staging;\u003c/p\u003e\n\u003cp\u003e③ Multicenter RCTs should be conducted to compare the long-term efficacy (\u0026gt;5 years) of arthroscopic decompression with that of radial shortening osteotomy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that arthroscopic lunate decompression combined with K-wire fixation is an effective minimally invasive approach for treating Lichtman stage II\u0026ndash;IIIa KD, which is particularly suitable for young patients and those with high functional demands on their hands. Early- to mid-stage KD patients may consider minimally invasive decompression combined with short-term fixation to maximize wrist function preservation. However, long-term outcomes require further validation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026bull; CI: Confidence Interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; ICC: Intraclass Correlation Coefficient\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; KD: Kienb\u0026ouml;ck\u0026rsquo;s Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; MCID: Minimal Clinically Important Difference\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; MICE: Multiple Imputation by Chained Equations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; MRI: Magnetic Resonance Imaging\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; NSAIDs: Nonsteroidal Anti-Inflammatory Drugs\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; ROM: Range of Motion\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; SD: Standard Deviation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; VAS: Visual Analog Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; VEGF: Vascular Endothelial Growth Factor\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eL.C.L. drafted the manuscript and collected clinical cases. Y.Y.C. performed statistical analysis and conducted literature collection. Z.F., P.J.D. and T.X.F. designed the surgical protocols and provided clinical expertise. W.X.F. conceptualized the main ideas of the study. W.X. supervised the study, provided critical revisions, and obtained ethical approval. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunded by Ningbo Clinical Research Center for Orthopedics, Sports Medicine \u0026amp; Rehabilitation (2024L004).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNingbo Top Medical and Health Research Program (2022020506).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eDepartment of Hand Microsurgery and Plastic Reconstructive Surgery,\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNingbo No. 6 Hospital, Ningbo, China\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eNingbo Clinical Research Center for Orthopedics, Sports Medicine \u0026amp; Rehabilitation, Ningbo, China\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eYuyao Ditang Central Health Center, Ningbo, Zhejiang Province, China\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalva-Coll G, Esplugas M, Carre\u0026ntilde;o A, Lluch-Bergada A. Kienb\u0026ouml;ck\u0026rsquo;s disease: preventing disease progression in early-stage disease. Journal of Hand Surgery (European Volume). 2023;48(3):246-56.\u003c/li\u003e\n\u003cli\u003eInnes L, Strauch RJ. Systematic Review of the Treatment of Kienbck\u0026apos;s Disease in Its Early and Late Stages. Journal of Hand Surgery. 2010;35(5):713-7.e4.\u003c/li\u003e\n\u003cli\u003eEric R W, Alexander R G. Arthroscopic Management of Kienb\u0026ouml;ck Disease. Hand Clin. 2022;38(4).\u003c/li\u003e\n\u003cli\u003eKamrani RS, Najafi E, Azizi H, Zanjani LO. Outcomes of arthroscopic lunate core decompression versus radial osteotomy in treatment of Kienb\u0026ouml;ck disease. The Journal of Hand Surgery. 2022;47(7):692. e1-. e8.\u003c/li\u003e\n\u003cli\u003eKoh I-H, Kim H-S, Kim S-H, Oh W-T, Suk Y-J, Choi Y-R. Examining the efficacy of arthroscopic scaphocapitate arthrodesis for advanced Kienbock\u0026rsquo;s disease: clinical and radiological outcomes. Clinics in Orthopedic Surgery. 2024;16(3):448.\u003c/li\u003e\n\u003cli\u003ePark MJ, Ahn JH. Arthroscopically Assisted Reduction and Percutaneous Fixation of Dorsal Perilunate Dislocations and Fracture-Dislocations. Arthroscopy: The Journal of Arthroscopic \u0026amp; Related Surgery. 2005;21(9):1153.e1-.e9.\u003c/li\u003e\n\u003cli\u003eBhatia, Deepak N. Arthroscopic Reduction and Stabilization of Chronic Perilunate Wrist Dislocations. Arthroscopy Techniques. 2016;5(2):e281-e90.\u003c/li\u003e\n\u003cli\u003eSaremi H, Shiruei S, Moradi A. Arthroscopic Treatment of kienb\u0026ouml;ck disease: mid-term outcome of arthroscopic lunate core decompression. The Journal of Hand Surgery. 2024;49(11):1143. e1-. e7.\u003c/li\u003e\n\u003cli\u003eTsujimoto R, Maeda J, Abe Y, Arima K, Tomita M, Koseki H, et al. Epidemiology of Kienb\u0026ouml;ck\u0026rsquo;s disease in middle-aged and elderly Japanese women. Orthopedics. 2015;38(1):e14-e8.\u003c/li\u003e\n\u003cli\u003eLichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock\u0026apos;s disease: the state of the art and a look at the future. Journal of Hand Surgery (European Volume). 2010;35(7):549-54.\u003c/li\u003e\n\u003cli\u003eChidambaram G, Rajasekar S, Rajappa S. Bone Grafting and Unloading Procedures for Stage 1\u0026ndash;3a Kienbock\u0026rsquo;s Disease. Journal of Orthopedic Case Reports. 2025;15(7):59.\u003c/li\u003e\n\u003cli\u003eWang SL, Hu YB, Chen H, Tao B, Zhang JS. Efficacy of bone marrow stem cells combined with core decompression in the treatment of osteonecrosis of the femoral head: A PRISMA-compliant meta-analysis. Medicine. 2020;99(25):e20509.\u003c/li\u003e\n\u003cli\u003eGokce V, Oflaz H, Dulgeroglu A, Bora A, Gunal I. Kirschner wire fixation for scaphoid fractures: an experimental study in synthetic bones. Journal of Hand Surgery European Volume. 2011;36(4):325.\u003c/li\u003e\n\u003cli\u003eViswanath A, Talwalkar S. Recent advances and future trends in wrist arthroscopy. Journal of Arthroscopic Surgery and Sports Medicine. 2020;1(1):65-72.\u003c/li\u003e\n\u003cli\u003eElshahhat A, Nour K, Abed Y. Scaphocapitate fusion in stage III Kienb\u0026ouml;ck\u0026rsquo;s disease: effects of lunarectomy on postoperative pain and function. Archives of Orthopedic and Trauma Surgery. 2025;145(1):1-15.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kienböck’s disease, Wrist arthroscopy, Lunate decompression, K-Wire fixation, Minimally invasive surgery","lastPublishedDoi":"10.21203/rs.3.rs-7409441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7409441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eKienb\u0026ouml;ck\u0026rsquo;s disease, characterized by lunate avascular necrosis, requires effective interventions to relieve pain and restore function. This study evaluated arthroscopic lunate decompression with K-wire fixation for Lichtman stage II\u0026ndash;IIIa patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort of 32 patients (18 stage II, 14 stage IIIa) treated at Ningbo No. 6 Hospital (2018\u0026ndash;2022) was analyzed, with a 12-month follow-up. The sample size was determined via a power calculation (α\u0026thinsp;=\u0026thinsp;0.05, power\u0026thinsp;=\u0026thinsp;0.80) on the basis of VAS score reduction. The primary outcomes were visual analog scale (VAS) pain scores and Mayo wrist scores; the secondary outcomes included grip strength, wrist range of motion (ROM), and the lunate height index. Paired t tests, independent samples t tests, and Cohen\u0026rsquo;s d effect sizes were used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe VAS score decreased to 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 at 3 months and 2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70 at 6 months, from 7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 to 1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 at 12 months (mean difference: 5.60, 95% CI: 5.12\u0026ndash;6.08, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d\u0026thinsp;=\u0026thinsp;5.89), exceeding the minimal clinically important difference (MCID, 1.5 points). The Mayo wrist score improved from 44.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56 to 86.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85 (mean difference: 41.43, 95% CI: 37.92\u0026ndash;44.94, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Cohen's d\u0026thinsp;=\u0026thinsp;4.85). The grip strength reached 86.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25% of that of the contralateral side. Stage II patients had lower VAS scores (1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38) than did stage IIIa patients (1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43, P\u0026thinsp;=\u0026thinsp;0.017). The complications included transient nerve numbness, pin-site infections (15.6% each), and wrist stiffness (12.5%), all of which were resolved conservatively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eArthroscopic lunate decompression with K-wire fixation significantly reduces pain and improves function in patients with stage II\u0026ndash;IIIa KD, with superior pain relief in patients with stage II disease. This minimally invasive approach shows promise but requires multicenter randomized controlled trials for long-term validation.\u003c/p\u003e","manuscriptTitle":"Arthroscopic Lunate Decompression with K-Wire Fixation for Lichtman Stages II–IIIa Kienböck’s Disease: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:08:53","doi":"10.21203/rs.3.rs-7409441/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"df33b868-fb9d-4b54-81f2-6c4051f4c6e5","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-30T04:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 01:08:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7409441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7409441","identity":"rs-7409441","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}