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Matković A, Ferenc T, Dimnjaković D, Jurjević N, Vidjak V, Matković BR. Osteochondritis Dissecans of the Elbow in Overhead Athletes: A Comprehensive Narrative Review. Diagnostics (Basel) 2024; 14:916. [PMID: 38732330 PMCID: PMC11083537 DOI: 10.3390/diagnostics14090916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science. Individuals with elbow OCD were usually 10-17 years of age with incidence and prevalence varying between studies, depending on the sport activity of the patients. The etiology of OCD lesions is multifactorial, and the main causes are believed to be repetitive trauma, the biomechanical disproportion of the articular surfaces, poor capitellar vascular supply, and inflammatory and genetic factors. Athletes usually presented with elbow pain and mechanical symptoms. The mainstay for the diagnosis of elbow OCD is MRI. The treatment of elbow OCD lesions should be conservative in cases of stable lesions, while various types of surgical treatment are suggested in unstable lesions, depending mainly on the size and localization of the lesion. The awareness of medical practitioners and the timely diagnosis of OCD lesions in OHAs are key to favorable outcomes.
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Affiliation(s)
- Andro Matković
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia; (A.M.)
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia; (A.M.)
| | - Damjan Dimnjaković
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nikolina Jurjević
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia; (A.M.)
| | - Vinko Vidjak
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia; (A.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Leal J, Hones KM, Hao KA, Slaton PT, Roach RP. Arthroscopy and Microfracture for Osteochondritis Dissecans of the Capitellum in Adolescent Athletes Shows Favorable Return to Sport: A Systematic Review. Arthroscopy 2024; 40:1325-1339. [PMID: 37714441 DOI: 10.1016/j.arthro.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications. METHODS A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations. CONCLUSIONS Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Justin Leal
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A..
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | | | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
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Yehyawi S, Zielinski EM, Bartkiw M, Peck K, Hastings H. Five-Year Follow-up of Adolescent Gymnasts After Surgical Treatment of Osteochondritis Dissecans of the Elbow. J Hand Surg Am 2023:S0363-5023(22)00770-5. [PMID: 37115144 DOI: 10.1016/j.jhsa.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/26/2022] [Accepted: 12/11/2022] [Indexed: 04/29/2023]
Abstract
PURPOSE Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition. METHODS A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows. RESULTS Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition. CONCLUSIONS The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Emily Marie Zielinski
- Department of Orthopedic Surgery, Indiana University School of Medicine, IU Health University Hospital, Indianapolis, IN
| | - Mykola Bartkiw
- Department of Orthopaedic Surgery, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Kathryn Peck
- Indiana Hand to Shoulder Center, Indianapolis, IN.
| | - Hill Hastings
- Telluride Hand Surgery, Telluride, CO; Indiana Hand to Shoulder Center, Indianapolis, IN; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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Nissen C, Bohn DC, Crepeau A, Edmonds E, Ganley T, Kostyun R, Lawrence JTR, Pace JL, Saluan P, Uquillas C, Wall E, Wilson PL, Bae DS. Reliability of Radiographic Imaging Characteristics for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2022; 50:3948-3955. [PMID: 36326355 DOI: 10.1177/03635465221130452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking. PURPOSE To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Anteroposterior, lateral, and oblique radiographs for 29 cases were reviewed by 7 orthopaedic surgeons. Images were assessed for elbow anthropometry and morphology, OCD presence, lesion characteristics, the presence of progeny bone and progeny features, and radial head abnormalities. Intra- and interrater reliability was assessed using Fleiss and Cohen kappa for nominal variables and intraclass correlation coefficients (ICCs) for continuous variables. RESULTS Surgeons demonstrated substantial to excellent inter- and intrarater reliability when assessing elbow characteristics: anthropometric (interrater ICC, 0.94-0.99; intrarater ICC, 0.82-0.96) and morphologic (Fleiss, 0.61-0.76; Cohen, 0.68). When the OCD lesion was assessed, fair to moderate interrater agreement was found for classifying the absence or presence of a lesion (Fleiss, 0.28-0.46) and the location of the OCD (Fleiss, 0.24-0.52), poor agreement for assessing the contour of the lesion (Fleiss, 0.00-0.09), and excellent agreement for measuring the size of the lesion (ICC, 0.82-0.94). Poor to fair interrater agreement was found for radial head abnormalities (Fleiss, 0.00-0.27). Progeny bone visualization and fragmentation demonstrated moderate interrater agreement (Fleiss, 0.43-0.47) where displacement of the bone demonstrated poor interrater agreement (Fleiss, 0.11-0.16). Intrarater agreement for OCD lesion characteristics, progeny bone visualization, and progeny bone features was moderate to excellent. CONCLUSION Given only the fair to moderate agreement among raters for identifying OCD on radiographs, this imaging modality may not serve as a dependable screening tool in isolation. Additional imaging should be obtained if the clinical presentation suggests capitellar OCD and a definitive diagnosis is not possible with radiographs. However, clinicians can reliability measure the size of radiographically apparent OCD, suggesting that radiographs may serve as an appropriate imaging modality for follow-up care.
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Affiliation(s)
| | - Carl Nissen
- PRiSM Sports Medicine, Hartford, Connecticut, USA; Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | - Allison Crepeau
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Eric Edmonds
- Rady Children's Hospital, San Diego, California, USA; University of California San Diego, San Diego, California, USA
| | - Theodore Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Regina Kostyun
- Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | - J Todd R Lawrence
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | | | - Carlos Uquillas
- Cedars Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Eric Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald S Bae
- Boston Children's Hospital, Boston, Massachusetts, USA.,Investigation performed at the Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
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Michelin RM, Gornick BR, Schlechter JA. Adolescent Athletes Achieve High Levels of Athletic and Daily Function After Arthroscopic Marrow Stimulation for Elbow Capitellar Osteochondritis Dissecans. Arthrosc Sports Med Rehabil 2022; 4:e1985-e1992. [PMID: 36579032 PMCID: PMC9791882 DOI: 10.1016/j.asmr.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/16/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To determine the functional outcomes of adolescent athletes treated with arthroscopic marrow stimulation/microfracture for elbow capitellar osteochondritis dissecans (OCD). Methods The medical records for all patients younger than 18 years of age with capitellar OCD who underwent arthroscopic treatment at a single institution were retrospectively reviewed. The variables examined included patient characteristics, bone age, pre- and postoperative lesion grade/size and range of motion (ROM), intraoperative lesion grade/size, time to postoperative return to sport, and validated outcome scores. Results Twenty patients with 21 treated elbows met the study's inclusion criteria. Three patients were not available for follow-up, leaving 18 of 21 (85.7%) elbows in the final cohort. Mean age and follow-up was 14.1 and 4.4 years, respectively. All 18 elbows were treated with diagnostic arthroscopy, arthroscopic debridement with loose body removal as indicated, and marrow stimulation. Sixteen of 18 (88.9%) elbows returned to sports postoperatively, with 12 of 18 (66.7%) elbows returning to their primary sport at the same level or higher. Overall, there were significant improvements in elbow ROM (132.8°, range 120°-140° postoperatively, compared with 122.1°, range 80°-140° preoperatively) (P = .002) and excellent Quick Disabilities of the Arm, Shoulder and Hand scores (mean 2.3 ± 5.1), as well as Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow scores (mean 94.1 ± 8.7) in those who returned to sports. There was no correlation with outcome or return to sport for preoperative lesion grade/size, bone age, physeal status or open versus arthroscopic treatment. Conclusions Arthroscopic debridement and marrow stimulation for capitellar OCD in adolescent athletes leads to improvements in ROM, as well as a high rate of return to sport, and high levels of athletic and daily functional activity during follow-up, regardless of bone age and lesion grade/size at time of surgery. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Richard M. Michelin
- Address correspondence to Richard M. Michelin, D.O., Department of Pediatric Orthopaedic Surgery, Children’s Hospital of Orange County, 1201 W La Veta Ave., Orange, CA 92868.
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Sayani J, Plotkin T, Burchette DT, Phadnis J. Treatment Strategies and Outcomes for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2021; 49:4018-4029. [PMID: 33886390 DOI: 10.1177/03635465211000763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject. PURPOSE To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment). RESULTS No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions. CONCLUSION Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.
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Affiliation(s)
| | | | | | - Joideep Phadnis
- Brighton and Sussex University Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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7
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Wessel LE, Eliasberg CD, Bowen E, Sutton KM. Shoulder and elbow pathology in the female athlete: sex-specific considerations. J Shoulder Elbow Surg 2021; 30:977-985. [PMID: 33220412 DOI: 10.1016/j.jse.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
Unique biologic and biomechanical aspects of the female body make women more prone to certain orthopedic injuries. Sex differences are well understood with regard to certain orthopedic pathologies such as anterior cruciate ligament injury, hallux valgus, carpal tunnel, and carpometacarpal joint arthritis; however, sex differences are less commonly discussed with regard to shoulder and elbow pathology. The purpose of this review is to elucidate sex differences specific to sports-related shoulder and elbow injuries in the female athlete population.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Edward Bowen
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karen M Sutton
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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Cheng C, Milewski MD, Nepple JJ, Reuman HS, Nissen CW. Predictive Role of Symptom Duration Before the Initial Clinical Presentation of Adolescents With Capitellar Osteochondritis Dissecans on Preoperative and Postoperative Measures: A Systematic Review. Orthop J Sports Med 2019; 7:2325967118825059. [PMID: 30800689 PMCID: PMC6378452 DOI: 10.1177/2325967118825059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) of the capitellum is an increasingly recognized disease affecting young athletes. Because lesion progression is common, early identification is potentially beneficial for an athlete’s treatment and recovery. However, there is currently no analysis available that evaluates the impact of symptom duration on preoperative and postoperative outcomes. Purpose/Hypothesis: The purpose of this study was to perform a systematic review of surgically treated OCD lesions to examine the effect of symptom duration before the initial presentation on preoperative and postoperative outcomes. We hypothesized that a longer symptom duration would correlate with more severe preoperative signs and symptoms and poorer postoperative outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: Ovid MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects were queried for studies evaluating symptom duration before the clinical presentation of capitellar OCD and surgical outcomes. A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: A total of 23 studies reporting outcomes in 258 patients (mean patient age, 14.4 ± 1.5 years) were analyzed. Locking as a chief complaint predominated in a greater proportion of patients who presented with a longer history of OCD symptoms (P = .007). A longer symptom duration also correlated with a longer time to return to sport (P = .008) and older age (P < .001). Range of motion limitations as both a chief complaint and a physical examination finding correlated with a longer symptom duration (P = .014 and .001, respectively). Symptom duration did not show a relationship with most postoperative outcomes, including the return-to-sport rate (P = .172), which ranged from 70.7% to 91.1% depending on the surgical procedure performed. No significant difference was observed between symptom duration and the surgical procedure performed (P = .376). Conclusion: Advanced OCD lesions were observed in patients with a longer symptom duration. However, treatment specifics rather than symptom duration correlated best with return to sport for patients with advanced OCD lesions requiring surgery. The earlier detection of capitellar OCD may be valuable in reducing the severity of lesions, the time to return to sport, and potential need for surgery in young athletes.
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Affiliation(s)
- Christopher Cheng
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Matthew D Milewski
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Hannah S Reuman
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Carl W Nissen
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Bexkens R, van Bergen CJA, van den Bekerom MPJ, Kerkhoffs GMMJ, Eygendaal D. Decreased Defect Size and Partial Restoration of Subchondral Bone on Computed Tomography After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2018; 46:2954-2959. [PMID: 30141965 DOI: 10.1177/0363546518790455] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow. PURPOSE To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good-complete osseous union or ossification; fair-incomplete osseous union or ossification but improved; poor-no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan. RESULTS There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05). CONCLUSION Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.
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Affiliation(s)
- Rens Bexkens
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Guerra E, Fabbri D, Cavallo M, Marinelli A, Rotini R. Treatment of Capitellar Osteochondritis Dissecans With a Novel Regenerative Technique: Case Report of 3 Patients After 4 Years. Orthop J Sports Med 2018; 6:2325967118795831. [PMID: 30228993 PMCID: PMC6137555 DOI: 10.1177/2325967118795831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Daniele Fabbri
- IRCCS Galeazzi Orthopaedic Institute, San Siro Clinical Institute, Milan, Italy
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11
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Ueda Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Onishi K, Hoshika S, Hamada H. Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athletes: 5- to 12-Year Follow-up. Orthop J Sports Med 2017; 5:2325967117744537. [PMID: 29276715 PMCID: PMC5734470 DOI: 10.1177/2325967117744537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial. Purpose To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes. Study Design Case series; Level of evidence, 4. Methods A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups. Results All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 (P = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; P = .002). Extension ROM showed significant improvement in both groups (group 1: from -8° to 3°; group 2: from -17° to -1°; P < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups (P = .005). Conclusion Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions.
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Affiliation(s)
- Yusuke Ueda
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Norimasa Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Keisuke Matsuki
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Morihito Tokai
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Kazutomo Onishi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Shota Hoshika
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroshige Hamada
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
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Trofa DP, Gancarczyk SM, Lombardi JM, Makhni EC, Popkin CA, Ahmad CS. Visualization of the Capitellum During Elbow Arthroscopy: A Comparison of 3 Portal Techniques. Orthop J Sports Med 2017; 5:2325967117712228. [PMID: 28680895 PMCID: PMC5476331 DOI: 10.1177/2325967117712228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Capitellar osteochondritis dissecans (OCD) is a debilitating condition of unknown etiology for which various arthroscopic treatments are available. Prior data suggest that greater than 75% of the capitellum can be visualized arthroscopically through a dual lateral portal approach. However, there is no literature assessing arthroscopic visualization of the capitellum via alternative portals. Purpose: To determine the percentage of capitellum visualized using the dual lateral, distal ulnar and soft spot, and posterolateral and soft spot portal configurations in a cadaver model. Study Design: Descriptive laboratory study. Methods: Arthroscopy was performed on 12 fresh-frozen cadaver elbows, 4 for each of the following approaches: dual lateral, distal ulna, and posterolateral. Electrocautery was used to mark the most anterior, posterior, medial, and lateral points seen on the capitellum. The radiocapitellar joint was subsequently exposed through an extensile posterior dissection, and the surface anatomy was reconstructed using the Microscribe 3D digitizing system. Using Rhinoceros software, the percentage of capitellum surface area visualized by each approach was determined. Results: The mean percentage of capitellum visualized for the dual lateral, distal ulna, and posterolateral approaches was approximately 68.8%, 66.3%, and 63.5%, respectively. There was no significant difference between the percentage of capitellum seen among approaches (P = .68). On average, 66.5% of the capitellum was visible through these 3 arthroscopic approaches to the elbow. Conclusion: Approximately 66.5% of the capitellum is visualized through the popularized posterior arthroscopic portals, with no significant differences found between the 3 investigated approaches. Clinical Relevance: As determined in this cadaveric model investigation, each portal technique provides equivalent visualization for capitellar OCD pathology.
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Affiliation(s)
- David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Stephanie M Gancarczyk
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Joseph M Lombardi
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Eric C Makhni
- Department of Orthopaedics, Henry Ford Hospital and Wayne State University, West Bloomfield, Michigan, USA
| | - Charles A Popkin
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Christopher S Ahmad
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
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Kajiyama S, Muroi S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Osaki M. Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts. Orthop J Sports Med 2017; 5:2325967117692513. [PMID: 28321431 PMCID: PMC5347432 DOI: 10.1177/2325967117692513] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts. Purpose: To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed. Results: The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts (P < .01). Conclusion: Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD.
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Affiliation(s)
- Shiro Kajiyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Satoshi Muroi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Norimasa Takahashi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Keisuke Matsuki
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Nobuaki Kawai
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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14
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Eygendaal D, Bain G, Pederzini L, Poehling G. Osteochondritis dissecans of the elbow: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2015-000008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Mirzayan R, Lim MJ. Fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum in baseball players. J Shoulder Elbow Surg 2016; 25:1839-1847. [PMID: 27742247 DOI: 10.1016/j.jse.2016.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the capitellum is a rare yet debilitating injury seen in young athletes. This is the first report in the literature describing fresh osteochondral allograft transplantation (FOCAT) to treat OCD of the capitellum. METHODS Nine male baseball players (mean age, 15.3; range, 14-18 years), with OCD of the capitellum were treated with FOCAT. There were 6 pitchers and 3 position players. A ligament-sparing, mini-open approach was used. A fresh femoral hemicondyle was used as a donor source. Of the 9 patients, 7 required 1 plug and 2 required 2 plugs. The average plug diameter was 11 mm (range, 8-18 mm). Five plugs were press fit, and 4 required additional fixation. Clinical outcomes were evaluated at a mean follow-up of 48.4 months (range, 11-90 months). Preoperative and postoperative outcome scores were calculated using the paired t test. RESULTS The Mayo Elbow Performance score improved from an average 57.8 to 98.9 (P < .01). The Oxford Elbow Score improved from 22.4 to 44.8 (P < .01). The Disabilities of the Arm, Shoulder and Hand score improved from 35.2 to 5.4 (P < .01). The visual analog scale score improved from 7.8 to 0.5 (P < .01). The Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score improved from 32.6 to 82.5 (P < .01). All patients returned to throwing and were still active in their sport or played at least 2 years of baseball before leaving the sport unrelated to the elbow. CONCLUSIONS FOCAT for OCD of the capitellum in properly selected cases is a viable treatment with significant functional improvement and pain reduction in throwers.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Southern California Permanent Medical Group, Baldwin Park, CA, USA.
| | - Michael J Lim
- Middlesex Orthopedic Surgeons P.C., Middletown, CT, USA
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16
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van Bergen CJA, van den Ende KIM, ten Brinke B, Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. World J Orthop 2016; 7:102-108. [PMID: 26925381 PMCID: PMC4757654 DOI: 10.5312/wjo.v7.i2.102] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/16/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, an OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk. A high index of suspicion is warranted to prevent delay in the diagnosis. Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy. Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach. Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD. Numerous other surgical options have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this article is to provide a current concepts review of the etiology, clinical presentation, diagnosis, treatment, and outcomes of elbow OCD.
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17
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Abstract
BACKGROUND Limited data exist regarding the indications and expected outcomes of internal fixation of unstable in situ osteochondritis dissecans (OCD) lesions of the capitellum. The objective of this investigation was to characterize healing rates, clinical results, and functional outcomes of internal fixation of unstable in situ OCD lesions in adolescents. METHODS Retrospective analysis was performed of 26 elbows in 24 patients who underwent internal fixation for unstable in situ OCD. Mean age at surgery was 14.1 years; 7 patients had open physes. Mean lesion width and thickness were 12.0 and 5.4 mm, respectively. Demographic, clinical, and radiographic variables of patients who went on to healing versus revision procedures were compared with univariate analysis. Classification and regression tree analysis identified optimal threshold values associated with healing. Functional outcomes were assessed with the Mayo Elbow Performance Score, Timmerman, and Pediatric Outcomes Data Collection Instrument scores. Mean clinical follow-up was 39 months (range, 12 to 96 mo). RESULTS Twenty of 26 elbows healed. Patients who healed were younger (P=0.01) and had smaller sagittal plane lesion widths (P=0.03) than patients who underwent revision. Classification and regression tree analysis identified 15.3 years and 13 mm as the threshold values distinguishing patients who did and did not heal. Overall, mean arc of elbow motion improved from 109 degrees preoperatively to 127 degrees at last follow-up (P=0.001). Mean Mayo Elbow Performance Score improved from 68 to 92 (P<0.001). Of 18 questionnaire respondents, two thirds reported full return to their prior level of sports participation without elbow complaint; 9 had excellent final Timmerman scores, 5 good, and 4 fair. Mean Pediatric Outcomes Data Collection Instrument upper extremity and sports scores were 98 and 93, respectively. CONCLUSIONS Healing, return to sports, and good to excellent functional outcomes may be expected in the majority of patients undergoing internal fixation of unstable in situ OCD lesions of the capitellum, particularly in younger patients with lesions <13 mm in sagittal width. Higher levels of evidence must further differentiate the optimal surgical treatments of unstable OCD. LEVEL OF EVIDENCE Level IV.
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18
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Treatment of osteochondral lesions in the elbow: results after autologous osteochondral transplantation. Arch Orthop Trauma Surg 2015; 135:627-34. [PMID: 25801812 DOI: 10.1007/s00402-015-2204-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteochondral lesions in the elbow still remain a challenging field of surgery. In recent years promising clinical results were described for the osteochondral transplantation technique. The aim of this retrospective study was to evaluate the clinical and radiological outcome in the mid-term follow-up of a large cohort of patients following osteochondral transplantation in the elbow. METHODS 18 patients with advanced osteochondral lesions of the elbow treated by autologous osteochondral autograft cylinders and a minimum follow-up of 36 months were included in the study. The Broberg-Morrey score (BMS) and the American Shoulder and Elbow score (ASES) were used to assess elbow function and pain, respectively. The joint status was analyzed using plain radiographs and MRI scans taken from all patients at recent follow-up. In addition, the ipsilateral knee joint was examined for donor-site morbidity using the Lysholm knee score. RESULTS 14 patients were evaluated with a mean follow-up of 7 years (range 3-14 years). The mean BMS was 95.1 (range 72-100) points. The ASES score also showed promising results: pain at worst 1.5 (range 0-5) points, pain at rest 0.4 (range 0-5) points, pain lifting loads 2.8 (range 0-8) points, repetitive movement pain 1.5 (range 0-8) points. The range of motion of the injured elbow was free and equal to the contralateral side. Signs of osteoarthritis could be found on plain radiographs in three patients. The MRIs at follow-up showed graft viability in all patients. However, a slight incongruency of the chondral surface could be detected in two patients. The average Lysholm score was 90.9 (range 0-70) points. CONCLUSIONS Osteochondral transplantation in the elbow leads to both clinical and radiographic good-to-excellent mid-term results and therefore represents a reasonable treatment option for advanced osteochondral lesions in the elbow. LEVEL OF EVIDENCE Retrospective study; Therapeutic Level IV.
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20
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Hammoud S, Sgromolo N, Atanda A. The approach to elbow pain in the pediatric and adolescent throwing athlete. PHYSICIAN SPORTSMED 2014; 42:52-68. [PMID: 24565822 DOI: 10.3810/psm.2014.02.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elbow pain in pediatric throwing athletes can be very concerning and challenging to diagnose. Diagnosis involves determining whether the injury is chronic or acute in nature and the anatomical location of the pain. Physicians should be aware of the sport-specific forces that predispose athletes with immature skeletons to injury and should be familiar with the common presentations of these injuries. In order to narrow the diagnosis, physicians should gather a detailed history of how and when the pain occurred in addition to performing a thorough physical exam that includes tests, such as the modified milking maneuver and the moving valgus stress test. Appropriate imaging helps physicians to confirm the diagnosis and elucidates any associated pathology in patients. In most cases, the treatment given to patients is conservative and involves rest, ice, non-steroidal anti-inflammatory drugs for pain, and an appropriate physical therapy regimen with a progressive return to play when symptoms have resolved. When patients fail to respond to conservative treatment, surgical intervention may be needed. Knowing when to refer patients for orthopedic evaluation helps athletes return to play quickly and safely.
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Affiliation(s)
- Sommer Hammoud
- Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA
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21
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Abstract
Osteochondritis dissecans affects the elbow of many young, skeletally immature athletes. The incidence of OCD in the elbow is second to its occurrence in the knee and similar to the incidence in the ankle. Young, athletically active individuals are at increased risk for developing this problem. There is a predilection for those involved in overhead-dominant sports and sports that require the arm to be a weight-bearing limb. The diagnosis is occurring earlier because of an increased awareness of the entity and the increased use of advanced imaging techniques, primarily magnetic resonance imaging. This earlier diagnosis has led to an increase in treatment ideas and modalities and ultimately improved care and outcomes.
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Affiliation(s)
- Carl W Nissen
- Elite Sports Medicine, 399 Farmington Ave, Farmington, CT 06032, USA; Department of Orthopaedics, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA.
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Byram IR, Kim HM, Levine WN, Ahmad CS. Elbow arthroscopic surgery update for sports medicine conditions. Am J Sports Med 2013; 41:2191-202. [PMID: 23572098 DOI: 10.1177/0363546513482106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity.
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Affiliation(s)
- Ian R Byram
- Center for Shoulder, Elbow and Sports Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
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Abrams GD, Mall NA, Fortier LA, Roller BL, Cole BJ. BioCartilage: Background and Operative Technique. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Wulf CA, Stone RM, Giveans MR, Lervick GN. Magnetic resonance imaging after arthroscopic microfracture of capitellar osteochondritis dissecans. Am J Sports Med 2012; 40:2549-56. [PMID: 23019252 DOI: 10.1177/0363546512458765] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the capitellum affects young athletes involved in elbow load-bearing activities. Unstable lesions are best managed surgically, although debate remains regarding the optimal method. Arthroscopic treatment allows rapid recovery, but the effect on the articular surface is undetermined. HYPOTHESIS The clinical outcome after arthroscopic microfracture of stage III/IV capitellum OCD would be successful in terms of return to sport and restoration of function, and there would be some evidence of articular restoration or repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We reviewed records of 10 consecutive adolescent patients (age ≤18 years) with stage III or IV OCD lesions of the capitellum managed with arthroscopic microfracture. The mean age at the time of surgery was 13.9 years (range, 10.8-18.5 years); 7 patients were skeletally immature and 3 were skeletally mature. Pre- and postoperative functional assessment included active range of motion, Mayo Elbow Performance Score (MEPS), and Timmerman/Andrews elbow score. All patients underwent plain radiographic and magnetic resonance imaging (MRI) evaluation at a minimum of 12 months (mean, 27 months; range, 12-49 months) and clinical evaluation at a minimum of 24 months (mean, 42 months; range, 27-54 months) after surgery. RESULTS The mean range of motion improved in both flexion (135.8°→140.7°, P = .112) and extension (20.4°→-2.2°, P = .005). The mean MEPS (70.5→97, P = .007) and Timmerman/Andrews elbow scores (116.4→193.0, P = .008) improved significantly. magnetic resonance imaging (MRI) evaluation demonstrated an improvement in overall joint congruence and the formation of a reparative articular surface in 8 of 10 (80%) patients. No reoperations or major complications were encountered. Six of 8 patients involved in competitive athletics returned to the same level of participation at an average of 5.1 months. CONCLUSION Arthroscopic OCD fragment excision and capitellar microfracture demonstrates good to excellent functional results in short-term follow-up. Follow-up MRI suggests potential for a reparative fibrocartilaginous articular surface. Longer term follow-up is necessary to determine durability of the technique.
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Affiliation(s)
- Corey A Wulf
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, MN 55345, USA
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25
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Bojanić I, Smoljanović T, Dokuzović S. Osteochondritis dissecans of the elbow: excellent results in teenage athletes treated by arthroscopic debridement and microfracture. Croat Med J 2012; 53:40-7. [PMID: 22351577 PMCID: PMC3284183 DOI: 10.3325/cmj.2012.53.40] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aim To extend the microfracture procedure, which has been proven successful on osteochondritis dissecans (OCD) lesions in the knee and ankle, to OCD lesions in the elbow. Methods Nine young patients were treated by arthroscopic debridement and microfracture by a single surgeon. The average age at operation was 15.0 years (median 15; range 12-19). The average length of the follow-up was 5.3 years (median 5; range 2-9). The follow-up included physical examination and patient interview with elbow function scoring. Success of treatment was determined according to pre-operative and follow-up Mayo Elbow Performance Index scores and the patients’ return to sports. Results Eight patients scored excellent results on the follow-up and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. Conclusions We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum.
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Affiliation(s)
- Ivan Bojanić
- Department of Orthopedic Surgery, University Hospital Center Zagreb, Zagreb, Croatia
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26
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Yeoh KM, King GJW, Faber KJ, Glazebrook MA, Athwal GS. Evidence-based indications for elbow arthroscopy. Arthroscopy 2012; 28:272-82. [PMID: 22244102 DOI: 10.1016/j.arthro.2011.10.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/02/2011] [Accepted: 10/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions. METHODS A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence. RESULTS There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade C(f) recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation). CONCLUSIONS The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Kwan M Yeoh
- Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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de Graaff F, Krijnen MR, Poolman RW, Willems WJ. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. Arthroscopy 2011; 27:986-93. [PMID: 21693350 DOI: 10.1016/j.arthro.2011.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 12/14/2010] [Accepted: 01/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. The purpose of this review is to evaluate the results of arthroscopic surgery, including debridement, fragment fixation, micro-fracturing, and osteochondral autografting, in athletes with OCD of the elbow. METHODS We searched PubMed, EMBASE, and the Cochrane library using the following main terms: osteochondritis dissecans, elbow, and surgical intervention. The 9 selected articles were criticized by use of a quality assessment tool derived from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. RESULTS The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. CONCLUSIONS This review suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for athletes with OCD. Nevertheless, larger studies with enhanced methodologic quality and longer follow-up should be performed to support this conclusion. LEVEL OF EVIDENCE Level III, systematic review of Level IV studies.
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Affiliation(s)
- Frank de Graaff
- Department of Orthopaedics and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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Abstract
Elbow injuries in the pediatric and adolescent population represent a spectrum of pathology that can be categorized as medial tension injuries, lateral compression injuries, and posterior shear injuries. Early and accurate diagnosis can improve outcomes for both nonoperative and operative treatments. Prevention strategies are important to help reduce the increasing incidence of elbow injuries in youth athletes.
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Affiliation(s)
- R Michael Greiwe
- Columbia University Medical Center, Department of Orthopaedic Surgery, 622 West 168th Street, PH11-1130, New York, NY 10032, USA
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29
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Abstract
Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. Unlike Panner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. The natural history of OCD is poorly understood, and degenerative joint disease may develop over time. Multiple modalities aid in diagnosis, including radiography, MRI, and magnetic resonance arthrography. Lesion size, location, and grade determine management, which should attempt to address subchondral bone loss and articular cartilage damage. Early, stable lesions are managed with rest. Surgery should be considered for unstable lesions. Most investigators advocate arthroscopic débridement with marrow stimulation. Fragment fixation and bone grafting also have provided good short-term results, but concerns persist regarding the healing potential of advanced lesions. Osteochondral autograft transplantation appears to be promising and should be reserved for larger, higher grade lesions. Clinical outcomes and return to sport are variable. Longer-term follow-up studies are necessary to fully assess surgical management, and patients must be counseled appropriately.
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Abstract
Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. The introduction of elbow arthroscopy in the treatment of osteochondritis dissecans of the capitellum permits a thorough lesion assessment and evaluation of the entire elbow joint with the ability to treat the lesion and coexistent pathology in a minimally invasive fashion. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising.
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Affiliation(s)
- Champ L Baker
- Hughston Clinic, 6262 Veterans Parkway, Columbus, GA 31909, USA.
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Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases. Knee Surg Sports Traumatol Arthrosc 2010; 18:831-5. [PMID: 19859694 DOI: 10.1007/s00167-009-0945-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
Abstract
This is the first report to describe a method of arthroscopic osteochondral fixation using absorbable pins to treat osteochondritis dissecans (OCD) of the capitellum. Four adolescent baseball players with OCD of the capitellum were treated, and good short-term results were obtained. During this arthroscopic procedure, the elbow was maintained in the maximum flexed position, and posterolateral portals were used to visualize the lesion, perform drilling, and insert the pins. This procedure is less invasive and easier to perform than other fixation procedures that require harvesting or production of autologous bone pegs. This is an effective method of fragment fixation with absorbable pins.
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Frank RM, Van Thiel GS, Slabaugh MA, Romeo AA, Cole BJ, Verma NN. Clinical outcomes after microfracture of the glenohumeral joint. Am J Sports Med 2010; 38:772-81. [PMID: 20093422 DOI: 10.1177/0363546509350304] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Microfracture is an effective surgical treatment for isolated, full-thickness cartilage defects with current data focused on applications in the knee. No studies describing clinical outcomes of patients who have undergone microfracture in the shoulder joint have been reported. HYPOTHESIS Treatment of glenohumeral joint articular defects using microfracture would demonstrate similar short-term clinical outcomes when compared with other joints. STUDY DESIGN Case series; Level of evidence, 4. METHODS From March 2001 to August 2007, 16 patients (17 shoulders) who underwent arthroscopic microfracture of the humeral head and/or glenoid surface were retrospectively reviewed. All patients were examined by an independent, blinded examiner and completed surveys containing the Simple Shoulder Test (SST), American Shoulder and Elbow Score (ASES), and visual analog scale (VAS). RESULTS Two patients were lost to follow-up, for a follow-up rate of 88%. Three patients went on to subsequent shoulder surgery and were considered to have failed results. The mean age was 37.0 years (range, 18-55 years) with an average follow-up of 27.8 months (range, 12.1-89.2 months). The average size of humeral and glenoid defects was 5.07 cm(2) (range, 1.0-7.84 cm(2)) and 1.66 cm(2) (range, 0.4-3.75 cm(2)), respectively. There was a statistically significant decrease from 5.6 +/- 1.7 to 1.9 +/- 1.4 (P < .01) in VAS after surgery as well as statistically significant improvements (P < .01) in SST (5.7 +/- 2.1 to 10.3 +/- 1.3) and ASES (44.3 +/- 15.3 to 86.3 +/- 10.5). Twelve (92.3%) patients claimed they would have the procedure again. CONCLUSION Microfracture of the glenohumeral joint provides a significant improvement in pain relief and shoulder function in patients with isolated, full-thickness chondral injuries. Longer term studies are required to determine if similar results are maintained over time.
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Abstract
Arthroscopy is emerging as an invaluable tool for diagnosing and treating elbow pathology. In addition to the advantages of less scarring, decreased risk of infection, less postoperative pain, and a more thorough visualization of the elbow joint, arthroscopy is particularly well suited to the treatment of athletes trying to minimize rehabilitation and inactivity. Indications for elbow arthroscopy now extend well beyond diagnosis and loose body removal, and include the treatment of impingement, arthritis, contractures, fragment stabilization for osteochondritis dessicans, and treatment of certain fractures. This article reviews the basic principles and techniques of elbow arthroscopy and their application to common sports-related conditions, such as valgus overload syndrome, medial collateral ligament insufficiency, and the various causes of lateral elbow pain. Newer applications of elbow arthroscopy in fracture care are addressed as well.
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Nishitani K, Nakagawa Y, Gotoh T, Kobayashi M, Nakamura T. Intraoperative acoustic evaluation of living human cartilage of the elbow and knee during mosaicplasty for osteochondritis dissecans of the elbow: an in vivo study. Am J Sports Med 2008; 36:2345-53. [PMID: 18796577 DOI: 10.1177/0363546508322898] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous osteochondral mosaicplasty for osteochondritis dissecans of the capitellum is being used increasingly in adolescent patients. Little research has been published on the material properties of living human cartilage of the elbow and knee. HYPOTHESIS The cartilage of the osteochondritis dissecans lesion is detected as degenerated by ultrasound. The material properties of the cartilage of the intact part of the elbow are not different from those of the intact knee except in thickness. STUDY DESIGN Descriptive laboratory study. METHODS The authors studied 10 young male athletes with osteochondritis dissecans of the capitellum who underwent mosaicplasty. An acoustic probe was used for measurement, and the wavelet transform method was used. Three parameters were used: signal intensity (index of cartilage stiffness), signal duration (index of roughness), and signal interval (index of thickness). RESULTS The cartilage of the osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. The cartilage of the radial head opposite the capitellum had significantly lower signal intensity and higher signal duration than did other sites. The signal intensity of the radial head was significantly higher in early-stage patients than in late-stage patients, although the macroscopic view was almost all intact. The signal intensity of the plug was decreased significantly after grafting. CONCLUSION The osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. Although the macroscopic view looked intact, the radial head cartilage was degenerated as measured acoustically. CLINICAL RELEVANCE Not only the cartilage of the capitellum but the cartilage of the radial head are acoustically degenerated in osteochondritis dissecans patients. Plugs might be damaged in the transplanting procedure, and further follow-up is necessary.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Wahegaonkar AL, Doi K, Hattori Y, Addosooki A. Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans. J Hand Surg Am 2007; 32:1454-61. [PMID: 17996784 DOI: 10.1016/j.jhsa.2007.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 08/22/2007] [Indexed: 02/02/2023]
Abstract
Osteochondritis dissecans (OCD) is a localized condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Various theories about its etiology have been proposed, but the exact etiology of OCD still remains obscure. Osteochondritis dissecans of the elbow is characterized by pain, swelling, and limitation of motion, usually in adolescence through early adulthood. An uncommon clinical entity, it occurs as a result of overuse injuries, especially throwing activities. The treatment of OCD has evolved from the removal of loose bodies to the resurfacing of defects with an osteochondral autogenous graft (mosaicplasty). Mosaicplasty is a relatively new and viable option for the treatment of advanced OCD of the capitellum. In this article, we describe the technique of mosaicplasty for OCD of the capitellum.
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Affiliation(s)
- Abhijeet L Wahegaonkar
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi- City, Yamaguchi, Japan.
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Davis JT, Idjadi JA, Siskosky MJ, ElAttrache NS. Dual direct lateral portals for treatment of osteochondritis dissecans of the capitellum: an anatomic study. Arthroscopy 2007; 23:723-8. [PMID: 17637407 DOI: 10.1016/j.arthro.2007.01.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 01/16/2007] [Accepted: 01/24/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantify the distance of dual direct lateral (posterolateral radiocapitellar) arthroscopic portals to the lateral ligamentous structures and to report the percentage of capitellum accessible through these portals. METHODS Arthroscopy was performed on 10 fresh-frozen cadaveric elbows via a standard 6-portal approach. The portals included dual direct lateral portals created in the posterolateral soft spot. The arthroscope was placed through one direct lateral portal; an arthroscopic electrocautery device was placed through the other direct lateral portal and was used to mark all accessible areas of the capitellum. Open dissection allowed measurement of the distances of the portals from the lateral ligamentous structures, as well as determination of the percentage of capitellum accessible through these portals. RESULTS The more ulnar of the dual lateral portals averaged 9.1 mm from the lateral ulnar collateral ligament, 11.5 mm from the annular ligament, and 13.1 mm from the radial collateral ligament. The more radial of the dual lateral portals averaged 1.5 mm, 9.7 mm, and 7.0 mm from these ligaments, respectively. Seventy-eight percent of the capitellum was accessible for instrumentation with these portals. CONCLUSIONS Correct placement of dual direct lateral portals does not disrupt the lateral ligamentous complex and allows access to a large portion of the capitellum. CLINICAL RELEVANCE Use of dual direct lateral portals is safe and practical for arthroscopic treatment of capitellar osteochondritis dissecans.
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Affiliation(s)
- J T Davis
- Southern Illinois Orthopaedic Clinic, Carbondale, Illinois, USA.
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Abstract
The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.
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Affiliation(s)
- Merzesh Magra
- Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Stoke-on-Trent, England
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Ellenbogenarthroskopie bei Kindern. ARTHROSKOPIE 2006. [DOI: 10.1007/s00142-006-0368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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