Modern Concepts in the Etiology and Pathogenesis of Kienbock Disease.

Our understanding of Kienbock disease has evolved significantly over the last decade with advances in the study of basic science and advanced imaging. Some patients are predisposed to the disease, and the evolution of the disease may be influenced by the patient's demographic. Both biomechanical and biological factors play a significant role. The morphology of the wrist and lunate influence loading mechanics through the central column. Both arterial and venous factors are important in the development of ischemia and the onset of a compartment syndrome of bone. Stability of the wrist plays a role. The disease affects the ligaments within and between the carpus and radius through synovitis or avulsion, and disruption of these can leading to collapse of the lunate and carpus. Better understanding of the disease pathogenesis will improve our ability to strategize surgical management.