Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that they have no conflict of interest. 10. J Hand Surg Eur Vol. 2023 Mar;48(3):246-256. doi: 10.1177/17531934221146851. Epub 2023 Feb 17. Kienböck's disease: preventing disease progression in early-stage disease. Salva-Coll G(1)(2)(3), Esplugas M(1), Carreño A(1)(4), Lluch-Bergada A(1)(5). Author information: (1)Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain. (2)Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain. (3)Ibacma Institute, Balearic Institute for Hand Surgery, Palma de Mallorca, Illes Balears, Spain. (4)Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain. (5)Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona. Comment in J Hand Surg Eur Vol. 2023 Nov;48(10):1094. doi: 10.1177/17531934231179387. Currently Kienböck's disease remains an 'unsolved' problem in hand surgery. Different factors have been associated with the avascular necrosis of the lunate. Mechanical, vascular and biological factors, alone or in combination, may have an influence in the aetiopathogenesis and determine the progress of the disease and even the results of the treatment. This is especially relevant in the early stages, in which conservative or surgical treatment may modify the natural history of the disease, maintaining the lunate structure and thus preserving the joint surfaces. There are multiple surgical treatments for Kienböck's disease in the early stages, before lunate collapse; each one is based on one of the possible factors that can cause avascular necrosis of the lunate. The objective is not only to treat symptoms but to prevent progression. This article is a review of the most frequent treatments used in the early stages and a personal view of the authors.Level of evidence: V. DOI: 10.1177/17531934221146851