Autologous Lunate Replacement in Kienbock’s: Systematic Review and Meta-Analysis

Abstract Kienböck's disease is avascular necrosis of the lunate, causing wrist pain, functional impairment, and osteoarthritis. Autologous lunate replacement with tendon arthroplasty, local pedicled osteochondral flaps, or free flaps has emerged as a joint-preserving alternative to prosthetic implants or salvage, aiming to restore carpal mechanics. This systematic review evaluated outcomes of autologous lunate replacement for Kienböck's disease. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies with ≥ 6 months follow-up using tendon arthroplasty, local flaps, or free vascularized bone flaps. Outcomes included pain, motion, grip strength, carpal alignment, complications, and reoperations. Pooled estimates used random-effects meta-analysis. Thirty-five nonrandomized studies (n = 593) were included. Tendon arthroplasty (palmaris longus, extensor carpi radialis longus, or pronator quadratus with or without bone core) was reported in 17 studies (n = 306), yielding flexion 46.6 degrees, extension 47.9 degrees, grip strength 75.4%, and complication/reoperation rates 6.5%/1.3%. Local pedicled osteochondral flaps—including capitate osteotomy (Graner), vascularized os pisiform (Saffar), and pedicled scaphoid—were described in 13 studies (n = 189), with flexion 45.2 degrees, extension 44.6 degrees, grip 80.9%, and complication/reoperation 8.7%/4.1%. Free vascularized femoral trochlea flaps in six studies (n = 98) achieved flexion 46.4 degrees, extension 42.7 degrees, and grip 82.7%, but with higher complication (25.5%) and reoperation (8.5%) rates. Autologous lunate replacement appears to preserve motion, relieve pain, and maintain function in patients with Kienböck's disease. Tendon arthroplasty remains the simplest technique, but it may provide lower grip strength. Local pedicled osteochondral flaps yield intermediate results with moderate strength recovery, while free osteochondral flaps tend to offer similar grip and carpal alignment at the cost of higher technical complexity and complication rates. Level III