Kienböck Disease: Timing of Diagnosis, Imaging and the Full Spectrum of Stage-Adapted Treatment

Kienböck disease is osteonecrosis of the lunate, and it is usually diagnosed late. In one series, symptoms had lasted a mean of 33 months before evaluation, and almost half of the wrists were Lichtman stage IIIB or worse at the first visit, when the options that preserve the lunate are already limited. This narrative review, written with the Scale for the Assessment of Narrative Review Articles (SANRA) as a checklist, summarises evidence published mainly between 2015 and 2026 with two emphases: the timing of diagnosis and the whole range of treatment. Registry data now give a measured incidence. Negative ulnar variance and capitate morphology carry quantified risk. Magnetic resonance imaging is needed when radiographs are normal, computed tomography upstages a third of radiographically staged wrists, and arthroscopy changes the plan in a substantial minority. Treatment runs from immobilisation, which can be definitive in children and low-demand adults, through joint levelling, capitate shortening, core decompression and revascularisation to limited fusion, proximal row carpectomy, implants and salvage. Comparative studies exist, including five small randomised trials, but their size, design and heterogeneity do not establish a consistently superior strategy at any stage. We relate each option to the stage at diagnosis and specify the studies still needed.