AI Article Synopsis
- This systematic literature review compares long-term outcomes of nonoperative treatment versus vascularized bone graft (VBG) in patients with Kienböck disease, using studies with at least 5 years of follow-up.
- The analysis included twelve studies, revealing that 40.2% of the nonoperative group experienced worsening conditions compared to only 17.0% in the VBG group, while no change in staging was seen in 52.4% and 77.8% of wrists, respectively.
- Overall, while VBG showed better improvements in radiographic stage and wrist pain, the differences were not significant enough to decisively favor VBG over nonoperative treatment, indicating a need for further research.
Article Abstract
Background: This systematic literature review compared long-term outcomes between nonoperative treatment and vascularized bone graft (VBG) in patients with Kienböck disease.
Methods: We systematically reviewed studies on nonoperative treatment and VBG for Kienböck disease with a mean follow-up of ≥ 5 years. A systematic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase databases to select relevant articles. Data on patient demographics, treatment details, and outcomes were extracted.
Results: Twelve studies (6 for nonoperative treatment and 6 for VBG) were included. The proportion of wrists showing worsening Lichtman stages after treatment was 40.2% (95% confidence interval [CI], 25.7-56.6) and 17.0% (95% CI, 10.2%-26.9%) in the nonoperative treatment group and VBG group, respectively. No change in the stage was observed in 52.4% (95% CI, 25.5%-78.0%) and 77.8% (95% CI, 66.7%-86.0%) of the wrists in the nonoperative treatment group and VBG group, respectively. The proportion of wrists without pain at the final follow-up was 29.2% (95% CI, 16.6%-46.1%) and 35.9% (95% CI, 22.6%-52.0%) in the nonoperative treatment group and VBG group, respectively. The proportion of wrists with more than a moderate degree was 30.4% (95% CI, 22.7%-39.4%) and 12.9% (95% CI, 5.5%-27.4%) in the nonoperative treatment group and VBG group, respectively. The 95% CIs of the mean wrist range of motion and mean grip strength ratio of the affected side to the contralateral side substantially overlapped in the two groups.
Conclusions: The VBG group showed greater improvement in the radiographic stage and wrist pain than did the nonoperative treatment group after treatment, but meaningful differences in parameters were not observed. Further well-designed studies are needed to confirm the superiority of VBG to nonoperative treatment regarding radiographic and clinical outcomes.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375810 | PMC |
| http://dx.doi.org/10.4055/cios22307 | DOI Listing |
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