Novel Technique in Late Stage Avascular Necrosis of Lunate: Tendon Interposition and Ligament Reconstruction with ECRL Tendon– A Case Report

Aim: To evaluate clinical and functional results of extensor carpi radialis longus tendon ball interposition for treatment of late stage avascular necrosis of lunate (kienbock’s disease).

Materials and Methods: Patient with stage 4 kienbock’s disease was treated with excision of lunate and ecrl tendon interposition to fill the cavity of the excised lunate bone. Tendon was split. One half was left in situ and the other was used to fill the cavity by passing it to the scaphoid and triquetrum. This also helps to maintain intercarpal stability. Functions were assessed using grip strength, range of movement of wrist, quick dash and visual analogue score. Radiological examination was performed to assess carpal height ratio and progression of arthritis.

Results: Long and bulky ecrl tendon acts as a spacer to fill the excised lunate. it also provides scapho lunate and lunate triquetral ligament reconstruction for inter carpal stability.

Conclusion: ECRL tendon used for interposition with reconstruction seems to be an effective treatment modality for late stage of kienbock’s disease.