The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienbockʹs disease

Objective: Treatment methods in Kienbockʹs disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a pal¬maris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. Methods: In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienbockʹs disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienbockʹs disease. The mean duration of follow- up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. Results: According to the Nakamuraʹs scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre- and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant differ¬ence was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. Conclusion: According to patient satisfaction rate and clinical results, the outcome of excision- al arthroplasty with palmaris longus tendon ball in Stage 3 Kienbockʹs disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.