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van den Bekerom MPJ, de Klerk HH, van Riet R. Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum. Shoulder Elbow 2024; 16:24-34. [PMID: 38425733 PMCID: PMC10901169 DOI: 10.1177/17585732231190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 03/02/2024]
Abstract
Osteochondritis dissecans of the capitellum is debilitating and is a potentially sports career-ending injury in a young and athletic population. Osteochondritis dissecans typically occurs in patients between the ages of 10 and 24 years, and boys are more commonly affected than girls. Conventional radiographs have low diagnostic accuracy, and magnetic resonance imaging (with or without contrast) or computed tomography may aid in accurate diagnosis. The primary indication for non-operative treatment is the presence of an intact cartilage cap on magnetic resonance imaging, indicating a "stable lesion." However, if operative treatment is necessary, various surgical procedures are available when operative treatment for an osteochondritis dissecans of the capitellum is considered, including open or arthroscopic removal of loose bodies, with or without microfracturing, fragment fixation, osteochondral autograft transplantation, and osteochondral allograft transplantation. The decision-making process for selecting the appropriate treatment considers factors such as the patient's characteristics, functional limitations, and lesion morphology.
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Affiliation(s)
- Michel PJ van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, The Netherlands
| | - Roger van Riet
- Orthopedic Center Antwerp, Antwerp, Belgium
- Monica Hospital, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
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Thomas JM, Chang EY, Ha AS, Bartolotta RJ, Bucknor MD, Caracciolo JT, Chen KC, Flug J, Kumaravel M, Raizman NM, Ross AB, Silvis ML, Surasi DS, Beaman FD. ACR Appropriateness Criteria® Chronic Elbow Pain. J Am Coll Radiol 2022; 19:S256-S265. [PMID: 36436956 DOI: 10.1016/j.jacr.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Chronic elbow pain can be osseous, soft tissue, cartilaginous, and nerve related in etiology. Imaging plays an important role in differentiating between these causes of chronic elbow pain. This document provides recommendations for imaging of chronic elbow pain in adult patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Jonelle M Thomas
- Vice-Chair of Clinical Affairs; Director, Radiology Informatics; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Roger J Bartolotta
- Division Chief, Musculoskeletal Imaging; Weill Cornell Medical College, New York, New York
| | - Matthew D Bucknor
- Associate Chair, Department of Radiology; University of California San Francisco, San Francisco, California
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; Section Head, MSK Imaging; MSK-RADS (Bone) Committee; Chairman, ACR MSK-RADS Committee
| | - Karen C Chen
- VA San Diego Healthcare System, San Diego, California; Musculoskeletal Radiology Section Chief Veterans Administration Healthcare System
| | - Jonathan Flug
- Mayo Clinic Arizona, Phoenix, Arizona; Chair, Radiology Quality Oversight Committee; Chair, Mayo Clinic Radiology Enterprise
| | - Manickam Kumaravel
- University of Texas Health Science Center (HSC), Houston, Texas; Committee on Emergency Radiology-General, Small, Emergency and/or Rural Practice; Assistant Vice President, University of Texas HSC, Houston, Texas
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, DC; American Academy of Orthopaedic Surgeons; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Matthew L Silvis
- Primary Care Physician; Director, Adult Ambulatory Care; Vice-Chair, Clinical Operations, Department of Family and Community Medicine; Division Chief, Primary Care Sports Medicine; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Devaki Shilpa Surasi
- Commission on Nuclear Medicine and Molecular Imaging; Patient Safety and Quality Officer, Department of Nuclear Medicine, MD Anderson Cancer Center; Chair-Elect, Junior Faculty Committee, MD Anderson Cancer Center; The University of Texas MD Anderson Cancer Center, Houston, Texas
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Swarup I, Chan C, Mehta N, Lawrence JT. Does an elbow arthrogram change management after closed reduction of mildly displaced lateral condyle fractures in children? J Pediatr Orthop B 2022; 31:7-11. [PMID: 32991375 DOI: 10.1097/bpb.0000000000000811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate whether an elbow arthrogram after closed reduction and percutaneous fixation of lateral condyle fractures results in a change in surgical management. This is a retrospective review of lateral condyle fractures managed with closed reduction and percutaneous fixation followed by an elbow arthrogram at our institution between 2008 and 2019. Chart and radiographic review was performed and operative notes were reviewed to determine rates of subsequent intervention after arthrogram. Descriptive statistics were used to summarize the data. This study included 47 patients. The majority of patients were male (34 patients, 72%), and the mean age at time of injury was 5.5 ± 2.6 years. The mean radiographic displacement was 2.6 mm (range 0.8-6.9 mm). All fractures were managed by fellowship-trained pediatric orthopaedic surgeons with an average of 10.5 years of experience (range 0-32 years). Fractures were stabilized with percutaneous pins in 44 patients (94%) and percutaneous screws in three patients (6%). No patients had subsequent changes in management after an elbow arthrogram. There were no complications related to performance of the arthrogram. Closed reduction and percutaneous fixation is often indicated for mildly displaced lateral condyle fractures. Articular reduction after percutaneous fixation is commonly assessed using an elbow arthrogram; however, it did not change surgical management in any case reviewed over the 10-year study period. While there seems to be little risk of performing an arthrogram, the clinical utility should be further evaluated.
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Affiliation(s)
- Ishaan Swarup
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Calvin Chan
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nishank Mehta
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John T Lawrence
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lenz R, Bonacker J, Mittelmeier W, Ellenrieder M, Tischer T. [What do orthopedic and trauma surgeons expect from radiologists when interpreting imaging of the elbow?]. Radiologe 2019; 58:968-975. [PMID: 30225771 DOI: 10.1007/s00117-018-0456-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CLINICAL ISSUE The elbow is a complex joint with a multitude of acute and chronic pathologies. In addition to the clinical examination, radiological diagnostics play a decisive role in the further therapeutic management. DIAGNOSTIC WORK-UP/PERFORMANCE While acute traumatic injuries often present with obvious structural changes and the need for rapid treatment decisions, chronic processes can present with less evident alterations. Especially in these cases there is a need for clear communication between the treating physician and the radiologist with respect to managing optimal imaging as the basis for a certain diagnosis and therefore optimal treatment. Basic prerequisites on both sides are detailed knowledge of all elbow pathologies, classifications and the spectrum of radiological diagnostic imaging. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS From the point of view of orthopedic surgeons the radiologist is responsible for the correct performance and interpretation of the necessary imaging procedures. The aim of this article is to give an overview of important aspects in the imaging of typical orthopedic/traumatic pathologies.
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Affiliation(s)
- R Lenz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland.
| | - J Bonacker
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - W Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - M Ellenrieder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - T Tischer
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
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LiMarzi GM, O'Dell MC, Scherer K, Pettis C, Wasyliw CW, Bancroft LW. Magnetic Resonance Arthrography of the Wrist and Elbow. Magn Reson Imaging Clin N Am 2016. [PMID: 26216774 DOI: 10.1016/j.mric.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Magnetic resonance (MR) arthrography of the wrist and elbow is useful for detecting a variety of intra-articular pathologies. MR dictations should address whether intrinsic ligament tears of the wrist are partial-thickness or full-thickness, and involve the dorsal, membranous, and/or volar components of the ligaments. With regard to elbow soft tissue pathology, partial-thickness tears of the anterior band of the ulnar collateral ligament in overhead-throwing athletes are well evaluated with MR arthrography. MR arthrography also is helpful in staging osteochondritis dissecans of the capitellum, caused by repetitive valgus impaction injury in adolescent or young adult baseball pitchers.
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Affiliation(s)
- Gary M LiMarzi
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - M Cody O'Dell
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Kurt Scherer
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Christopher Pettis
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Christopher W Wasyliw
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
| | - Laura W Bancroft
- Florida Hospital Diagnostic Radiology Residency Program, Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 East Rollins, Orlando, FL 32803, USA; Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA.
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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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Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elbow Surg 2016; 25:38-44. [PMID: 26271551 DOI: 10.1016/j.jse.2015.06.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/08/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is limited information on the validity of magnetic resonance imaging (MRI) in detection of biceps disease. The purpose of this study was to examine the measurement properties of noncontrasted MRI in diagnosis of biceps disease using arthroscopic surgery as the "gold standard." MATERIALS AND METHODS Prospectively collected surgical data of patients with impingement syndrome or rotator cuff tear, with biceps disease (study group) or without biceps disease (control group), were reviewed. MRI reports of radiologists with fellowship training in musculoskeletal imaging were retrospectively reviewed and compared with surgical findings. RESULTS Data of 183 (130 study and 53 control) patients (73 women [40%], 110 men [60%]; mean age, 62 years [standard deviation, 9]) who had undergone arthroscopic rotator cuff-related surgery during a period of 11 years were used for analysis. Sensitivity and specificity of MRI for detection of full tears of the biceps tendon were 0.54 and 0.98, respectively. Sensitivity and specificity were 0.27 and 0.86 for partial tears of the biceps tendon, respectively. For biceps subluxation or dislocation, sensitivity was 1.00 and specificity was 0.83. The areas under the receiver operating characteristic curves, which quantify the overall accuracy of the tests, were 0.57, 0.75, and 0.92 for partial tear, full tear, and instability of the biceps tendon, respectively. CONCLUSIONS Noncontrasted MRI has a low sensitivity and high specificity for detection of full-thickness tears of the biceps tendon. It is highly sensitive for diagnosis of instability of the long head of the biceps. However, its usefulness for diagnosis of partial tears of the biceps tendon remains limited.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Simon Fournier-Gosselin
- Centre de Santé et de Services Sociaux d'Arthabaska-et-de-l'Érable, Affilié Universitaire, Université de Sherbrooke, Québec, PQ, Canada
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amanda Pennings
- Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, ON, Canada
| | - Amr ElMaraghy
- Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Holtby
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Bibliography—Editors’ selection of current world literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31829d7cd1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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