The authors present a new concept in the treatment of Kienböck disease. They believe that the favorable outcome obtained with these different procedures (ie, either shortening of the radius or lengthening of the ulna) is due to the surgical decompression on the distal forearm. The procedure presented is called metaphyseal core decompression and it consists of curettage of the distal radius and ulna (the ulna has been excluded for the past 12 years) through a small cortical window. From 1976 to 2000, 48 patients were operated and retrospectively reviewed. Thirty-five were men and 13 were women, with an average age of 39 years (range, 18–64 years). The dominant limb was involved in 35 patients. All patients complained of pain and had decreased motion of the involved wrist. On radiographic examination, 4 had Lichtman stage 1, 17 had stage 2, and 25 had stage 3A. Patients who had stages 3B or 4 were excluded. Two patients had normal radiographic but MRI diagnostic for Kienböck disease, and were classified as stage 0. There were no postoperative complications reported and no patient had any additional procedure. The long-term follow-up reveals that metaphyseal core decompression produces results at least as good as other surgical procedures, with no postoperative complications.