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To the Editor: We read with interest the article by Turner et al in the 2017 issue of HAND. The authors reported a case of flexor tendon rupture due to Kienböck disease and stated that no prior cases have been reported. However, flexor tendon rupture associated with Kienböck disease has indeed been previously reported. In 1942, James reported a case of rupture of the flexor pollicis longus (FPL) and flexor profundus tendons of the index finger secondary to Kienböck disease. Niwa et al reported 6 cases of closed tendon rupture as a result of Kienböck disease and also reviewed 11 reported cases in English and 48 cases in Japanese. According to their article, flexor tendon rupture has been reported in a total of 14 cases. Recently, we also encountered a case with FPL rupture caused by Kienböck disease in a 74-year-old woman without marked wrist pain. Plain radiographs revealed Lichtman stage IV, and computed tomography (CT) showed protrusion of the collapsed lunate fragment toward the volar side (Figure 1). In intraoperative findings, the joint capsule was perforated by lunate fragments, as in previous reports 795511 HANXXX10.1177/1558944718795511HANDHirakawa et al letter2018