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Temporin K, Miyoshi Y, Miyamura S, Shimada K. Bone deformity in sports-related elbow osteoarthritis: influence of osteochondritis dissecans of the capitellum-a cross-sectional study. Arch Orthop Trauma Surg 2024; 144:1685-1691. [PMID: 38386060 DOI: 10.1007/s00402-024-05214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Sports activity can cause elbow osteoarthritis, which subsequently induces bone deformity. Osteochondritis dissecans (OCD) of the capitellum develops defects of articular surfaces and can exacerbate bone deformity. This study aimed to investigate whether OCD exacerbates deformities in sports-related elbow osteoarthritis. MATERIALS AND METHODS Twenty-one patients who underwent bilateral computed tomography preoperatively followed by surgery for sports-related elbow osteoarthritis were included. Patients were divided into two groups according to the presence or absence of an OCD history: OCD + (n = 6) and OCD- (n = 15). Bilateral three-dimensional bone models of the humerus, ulna, and radius were created using computed tomography data, and bone deformities were extracted by subtracting healthy mirror models from the affected models using a Boolean operation. Bone deformities were divided into 22 regions in the 3 bones. The volume of the deformity was estimated by correlating the anteroposterior and lateral diameters of the OCD and by comparing the two groups. RESULTS The anteroposterior diameter of the OCD correlated with the articular surface of the medial trochlear notch, whereas the lateral diameter correlated with the whole ulna, medial gutter of the ulna, whole radius, and lateral side of the radial head. The deformities were 2.2 times larger in the whole humerus, 1.9 times larger in the whole ulna, and 3.0 times larger in the whole radius in the OCD + group than in the OCD- group. The deformities were significantly larger in the OCD + group than in the OCD- group in the radial fossa, posterior capitellum, medial gutter, and lateral gutter in the humerus, medial gutter in the ulna, and lateral, anterior, and posterior sides of the radial head. CONCLUSION Larger OCD exacerbated deformity in elbow OA, and the presence of OCD exacerbated deformities in sports-related elbow OA. These results demonstrate the highlight of preventing OCD progression.
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Affiliation(s)
- Ko Temporin
- Center of Hand and Trauma Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-Ku, Osaka-Shi, Japan.
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
| | - Yuji Miyoshi
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kozo Shimada
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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2
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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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A Quantitative Analysis of Subchondral Bone Density Around Osteochondritis Dissecans Lesions of the Capitellum. J Hand Surg Am 2022; 47:790.e1-790.e11. [PMID: 34452800 DOI: 10.1016/j.jhsa.2021.06.020] [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: 06/20/2020] [Revised: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE In capitellar osteochondritis dissecans (OCD), unstable lesions generally demonstrate signs of subchondral sclerosis. We postulate that OCD lesions have abnormal subchondral bone density. We aimed to quantify the subchondral bone thickness around OCD lesions using conventional computed tomography (CT) imaging. METHODS This retrospective study included 15 patients with capitellar OCD (OCD group) and 12 patients with an unaffected radio-capitellar joint (control group). We constructed 3-dimensional humerus models using CT data and quantified the bone density with colored contour mapping to determine the subchondral bone thickness. We measured the thickness relative to the condylar height at the centroid and lateral, medial, superior, and inferior edge points of the OCD lesion, and compared the findings between the groups. We then correlated the CT measurements with the magnetic resonance imaging measurements. RESULTS Subchondral bone thickness at the centroid and lateral, medial, superior, and inferior edges in the OCD group was significantly higher than that in the control group. Correlation analyses revealed that the magnetic resonance imaging measurements highly correlated with the CT subchondral bone measurements. CONCLUSIONS We found that there is a zone of increased subchondral bone thickness around OCD lesions that should be considered during drilling, microfracture, or other reconstruction methods. We observed a high correlation with low errors between the measurements taken from conventional CT images and the measurements from magnetic resonance imaging, suggesting that both modalities are useful in clinical decision making. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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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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Outcomes of Osteochondral Autograft Transplantation in Pediatric Patients With Osteochondritis Dissecans of the Capitellum. J Hand Surg Am 2021; 46:1028.e1-1028.e15. [PMID: 33902975 DOI: 10.1016/j.jhsa.2021.02.024] [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: 01/23/2020] [Revised: 11/26/2020] [Accepted: 02/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the outcomes of osteochondral autograft transplantations in the treatment of osteochondritis dissecans of the capitellum in the pediatric population. METHODS Between 2011 and 2016, 15 patients who had undergone osteochondral autograft transplantation at a mean age of 13.7 years at surgery were identified. The donor site was from the superolateral, non-weight-bearing surface of the lateral femoral condyle of the ipsilateral knee. RESULTS Mean follow-up was 29.5 months, with no patients lost to follow-up. Mean arc of motion increased significantly from 121.9° preoperatively to 139.1° postoperatively. All 9 elite athletes returned to sports at an elite level: 7 returned to the same level of competition in the same sport, 1 retired from gymnastics due to multiple injuries but began diving at an elite level, and 1 retired from baseball unrelated to elbow symptoms but continued hockey at the same level. Of the 4 recreational athletes, all returned to sport. There were no intraoperative complications. The symptoms resolved completely in all but 2 patients, who improved over their preoperative condition. The donor site knee pain resolved in all patients at an average of 2.3 months. Postoperative imaging demonstrated the healing and incorporation of the plug in all patients. CONCLUSIONS In the treatment of osteochondritis dissecans of the capitellum, osteochondral autograft transplantation demonstrates excellent clinical and radiographic outcomes, with minimal short-term donor site morbidity and a high level of return to the sport. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.
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Affiliation(s)
- Juergen Bruns
- Wilhelmsburger Krankenhaus Groß-Sand, Hamburg, Germany,Juergen Bruns, Wilhelmsburger Krankenhaus Gross-Sand, Groß Sand 3, Hamburg, 21107, Germany.
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8
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Kamei K, Sasaki N, Sasaki E, Sasaki S, Kimura Y, Maeda S, Yamamoto Y, Ishibashi Y. Association Between Osteochondritis Dissecans of the Humeral Capitellum and Medial Epicondyle Lesion in Baseball Players. Orthop J Sports Med 2021; 9:23259671211007741. [PMID: 33889650 PMCID: PMC8033402 DOI: 10.1177/23259671211007741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) of the humeral capitellum occurs in
adolescent overhead athletes, and medial epicondyle (ME) lesions are also
common in this population. Purpose: To evaluate the association between elbow OCD and ME lesions in adolescent
baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study retrospectively evaluated adolescent baseball players with
unstable elbow OCD who underwent surgery between January 2000 and February
2020. Patients were excluded if they had osteoarthritis of the elbow. A
total of 139 elbows were included in this study (138 male and 1 female
athlete; mean ± SD age, 13.6 ± 1.5 years). The patients were first divided
into 2 groups based on OCD location: a central lesion group (72 elbows) and
a lateral group (67 elbows). Next, patients were divided according to OCD
size into a localized group (56 elbows) and a widespread group (83 elbows).
Finally, OCD lesions that were both lateral and widespread were defined as
lateral-widespread (60 elbows), resulting in 5 groups. ME apophyseal
fragmentation and elongation were evaluated and defined as ME lesions. We
then compared the relationship between OCD and ME lesions. Results: Of the 139 elbows, 63 (45.3%) had ME lesions. The prevalence of ME lesion was
higher in the lateral group than the central group (56.7% vs 34.7%;
P = .009) and higher in the widespread group than the
localized group (55.4% vs 30.4%; P = .004). Furthermore,
the prevalence ratio of ME lesion was significantly higher in the
lateral-widespread group than for other lesions (58.3% vs 35.4%;
P = .007). Conclusion: In patients undergoing surgery for capitellar OCD, the presence of ME lesions
was more commonly associated with lateral and widespread capitellar lesions
when compared with central and localized lesions.
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Affiliation(s)
- Keita Kamei
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norihiro Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Shugo Maeda
- Department of Orthopaedic Surgery, Aomori Rosai Hospital, Hachinohe, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Ueda Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Morioka T, Hoshika S, Takeuchi Y. Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years' Follow-up. Am J Sports Med 2021; 49:1145-1151. [PMID: 33705216 DOI: 10.1177/0363546521994558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. PURPOSE/HYPOTHESIS The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years' follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. RESULTS All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: -17° to 0°; group 2: -18° to -6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up (P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. CONCLUSION No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years' follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.
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Affiliation(s)
- Yusuke Ueda
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Hiroyuki Sugaya
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Norimasa Takahashi
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Morihito Tokai
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Takeshi Morioka
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Shota Hoshika
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Yasutaka Takeuchi
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
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Momma D, Onodera T, Kawamura D, Urita A, Matsui Y, Baba R, Funakoshi T, Kondo M, Endo T, Kondo E, Iwasaki N. Acellular Cartilage Repair Technique Based on Ultrapurified Alginate Gel Implantation for Advanced Capitellar Osteochondritis Dissecans. Orthop J Sports Med 2021; 9:2325967121989676. [PMID: 34250159 PMCID: PMC8237226 DOI: 10.1177/2325967121989676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background: One of the most important limitations of osteochondral autograft transplant
is the adverse effect on donor sites in the knee. Ultrapurified alginate
(UPAL) gel is a novel biomaterial that enhances hyaline-like cartilage
repair for articular defects. To avoid the need for knee cartilage
autografting when treating osteochondritis dissecans (OCD) of the
capitellum, we developed a surgical procedure involving a bone marrow
stimulation technique (BMST) augmented by implantation of UPAL gel. Hypothesis: BMST augmented by UPAL gel implantation improves the cartilage repair
capacity and provides satisfactory clinical outcomes in OCD of the
capitellum. Study Design: Case series; Level of evidence, 4. Methods: A total of 5 athletes with advanced capitellar OCD in the dominant elbow
underwent BMST augmented by implantation of UPAL gel. The osteochondral
defects were filled with UPAL gel after BMST. At a mean follow-up of 97
weeks, all patients were evaluated clinically and radiographically. Results: At final follow-up, all 5 patients had returned to competitive-level sports,
and 4 patients were free from elbow pain. The mean Timmerman-Andrews score
significantly improved from 100 to 194 points. Radiographically, all
patients exhibited graft incorporation and a normal contour of the
subchondral cortex. Magnetic resonance imaging showed that the preoperative
heterogeneity of the lesion had disappeared, and the signal intensity had
returned to normal. Arthroscopic examinations consistently exhibited
improvement in the International Cartilage Regeneration and Joint
Preservation Society (ICRS) grade of lesions from 3 or 4 to 1 or 2 in 4
patients at 85 weeks postoperatively. Histologic analysis of biopsy
specimens revealed an average total ICRS Visual Assessment Scale II
histologic score of 1060. Conclusion: The acellular cartilage repair technique using UPAL gel for advanced
capitellar OCD provided satisfactory clinical and radiographic results. The
present results suggest that this novel technique is a useful, minimally
invasive approach for treating cartilaginous lesions in athletes.
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Affiliation(s)
- Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tomohiro Onodera
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Kawamura
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Rikiya Baba
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | | | - Makoto Kondo
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan
| | | | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Kiyomatsu H, Takeba J, Imai H, Fujibuchi T, Inoue T, Jono A, Hino K, Miura H. Treatment of osteochondritis dissecans of the humeral capitellum with a fragment fixation method using absorbable pins. JSES Int 2021; 5:564-570. [PMID: 34136872 PMCID: PMC8178622 DOI: 10.1016/j.jseint.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/14/2022] Open
Abstract
Hypothesis This study aimed to investigate the results, indications, and limitations of absorbable pin fixation for osteochondritis dissecans of the humeral capitellum in the separation stage. Methods This study included 35 patients (mean age, 14.0 years). Patients were divided into two groups: Group A included those who obtained complete union within 6 months and Group B included those who did not observe complete union within 6 months. The clinical findings were compared between the groups. Results There were 26 and 6 patients in Groups A and B, respectively. Two patients did not obtain complete union. Clinical outcomes improved after the procedure. In univariate analysis, delayed union was associated with larger major diameter (P = .0004) and more depth (P = .03) of the osteochondral fragment measured by computed tomography, the presence of osteosclerosis in the subchondral bed on X-ray imaging (P = .003), and the presence of comminution of subchondral bone on ultrasound imaging (P = .01). In multivariate analysis, there was a significant difference only in the major diameter of the osteochondral fragment (P = .03). Receiver operating characteristic curves analysis shows that if the major diameter of the osteochondral fragment is 11 mm or less, 85% of patients achieve complete union of the osteochondral fragments within 6 months. Conclusion Absorbable pin fixation may be considered for the osteochondral fragments with major diameter of 11 mm or less and should not be considered for patients who demonstrate osteosclerosis in the subchondral bed or comminution of subchondral bone.
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Affiliation(s)
- Hiroshi Kiyomatsu
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Jun Takeba
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Taketsugu Fujibuchi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Takashi Inoue
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Akihiro Jono
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Kazunori Hino
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN
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Nishitani K, Nakagawa Y, Matsuda S. Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus-Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant. Orthop J Sports Med 2020; 8:2325967120962753. [PMID: 33225008 PMCID: PMC7653291 DOI: 10.1177/2325967120962753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The treatment of a meniscus-deficient knee is challenging, especially when
patients are young and active and are not favorable candidates for
prosthetic joint replacement. Hypothesis: We hypothesized that osteochondral autologous transplant (OAT) alone can be
considered a salvage treatment for patients with cartilage damage of the
lateral compartment of the knee, even with lateral meniscal deficiency, if
the knee alignment is close to neutral. Study Design: Case series; Level of evidence, 4. Methods: Patients with lateral meniscal deficiency, whose femorotibial angle was 170°
to 180° and who underwent OAT on the lateral compartment of the knee without
concomitant realignment osteotomy, were retrospectively included in this
study. The International Knee Documentation Committee (IKDC) subjective
score and the Japanese Orthopaedic Association score for knee osteoarthritis
(JOA knee score) were recorded. The International Cartilage Repair Society
(ICRS) cartilage repair assessment was used to evaluate the repaired
cartilage at second-look arthroscopy. Results: The study included 10 patients (mean ± SD age, 31.7 ± 19.7 years; 3 men and 7
women) who had ICRS grade 4 cartilage lesions (mean size, 3.5 ± 1.7
cm2); the mean follow-up was 73.8 ± 42.5 months. From
preoperative assessment to final follow-up, the mean IKDC subjective score
improved significantly from 53.5 ± 10.0 to 85.4 ± 10.1, and the mean JOA
knee score improved significantly from 81.0 ± 8.4 to 95.6 ± 5.3
(P = .004 for both). One patient with a femorotibial
angle of 170° underwent revision distal femoral osteotomy owing to prolonged
symptoms and progression of the valgus deformity, and 2 other patients with
femorotibial angles of 170° and 171° also exhibited progression of valgus
malalignment or low clinical scores postoperatively. Patients with a
favorable femorotibial angle (174°-178°) exhibited relieved symptoms and
preservation of femorotibial angle alignment within 1° of change at
follow-up. At second-look arthroscopy (n = 8 patients), 6 patients had an
ICRS score of nearly normal or normal. Conclusion: In the study patients, for which a meniscal allograft was unavailable, the
OAT procedure was able to relieve the symptoms associated with cartilage
lesions, even with lateral meniscal deficiency, when the femorotibial angle
alignment was close to neutral.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
- Kohei Nishitani, MD, PhD, Department of Orthopaedic Surgery,
Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo,
Kyoto 606-8507, Japan (
)
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization
Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
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Sasanuma H, Iijima Y, Saito T, Yano Y, Nakama S, Kameda M, Takeshita K. Satisfaction With Elbow Function and Return Status After Autologous Osteochondral Transplant for Capitellar Osteochondritis Dissecans in High School Baseball Players. Am J Sports Med 2020; 48:3057-3065. [PMID: 32941055 DOI: 10.1177/0363546520952782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral autograft transplant (OAT), a surgical treatment for capitellar osteochondritis dissecans (OCD), has favorable rates of elbow recovery and return to sports in adolescents. However, few reports have investigated how long patients continue to play baseball after OAT and their satisfaction with their treatment outcome. PURPOSE To evaluate the rate of boys who played baseball and received OAT for OCD in junior high school or earlier (age <15 years) and continued to play baseball in high school and the players' satisfaction with their elbow function during play. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 32 elbows of boys who played baseball and received OAT at age ≤15 years (mean, 14.1 years) were examined and divided into pitcher (n = 11) and nonpitcher (n = 21) groups according to their player position before surgery. The clinical Timmerman-Andrews score at the end of their high school baseball, participation percentage of players who continued to play baseball, and satisfaction level during play (on a scale of 0-10 during pitching and batting and in a 4-choice format) were compared between the 2 groups. RESULTS The Timmerman-Andrews scores significantly improved after surgery in both groups, with no significant difference between the groups. Of the 32 players, 30 (93.8%) continued to play baseball throughout high school, including all players in the pitcher group and 19 (90.5%) of those in the nonpitcher group. The percentage of players who continued to pitch was 55.6% (6/11) in the pitcher group. Satisfaction with elbow joint function at the time of pitching was significantly lower in the pitcher group. Further, 5 players reported being "a little unsatisfied" because of elbow pain during pitching. All of the players indicated satisfaction with elbow function during batting. CONCLUSION The percentage of players who received OAT for OCD in junior high school and continued to play baseball in high school was favorable. However, satisfaction with elbow function during throwing was lower in pitchers than in nonpitchers. CLINICAL RELEVANCE Before surgery, consent should be obtained from patients who are pitchers after it is explained that satisfaction with elbow joint function during pitching could be decreased after OAT.
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Affiliation(s)
- Hideyuki Sasanuma
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | - Yuki Iijima
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
| | - Tomohiro Saito
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
| | - Yuichiro Yano
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | - Sueo Nakama
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | | | - Katsushi Takeshita
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
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Bexkens R, Simeone FJ, Eygendaal D, van den Bekerom MPJ, Oh LS. Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging. Shoulder Elbow 2020; 12:284-293. [PMID: 32782483 PMCID: PMC7400717 DOI: 10.1177/1758573218821151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/17/2018] [Indexed: 11/16/2022]
Abstract
AIM (1) To determine the interobserver reliability of magnetic resonance classifications and lesion instability criteria for capitellar osteochondritis dissecans lesions and (2) to assess differences in reliability between subgroups. METHODS Magnetic resonance images of 20 patients with capitellar osteochondritis dissecans were reviewed by 33 observers, 18 orthopaedic surgeons and 15 musculoskeletal radiologists. Observers were asked to classify the osteochondritis dissecans according to classifications developed by Hepple, Dipaola/Nelson, Itsubo, as well as to apply the lesion instability criteria of DeSmet/Kijowski and Satake. Interobserver agreement was calculated using the multirater kappa (k) coefficient. RESULTS Interobserver agreement ranged from slight to fair: Hepple (k = 0.23); Dipaola/Nelson (k = 0.19); Itsubo (k = 0.18); DeSmet/Kijowksi (k = 0.16); Satake (k = 0.12). When classifications/instability criteria were dichotomized into either a stable or unstable osteochondritis dissecans, there was more agreement for Hepple (k = 0.52; p = .002), Dipaola/Nelson (k = 0.38; p = .015), DeSmet/Kijowski (k = 0.42; p = .001) and Satake (k = 0.41; p < .001). Overall, agreement was not associated with the number of years in practice or the number of osteochondritis dissecans cases encountered per year (p > .05). CONCLUSION One should be cautious when assigning grades using magnetic resonance classifications for capitellar osteochondritis dissecans. When making treatment decisions, one should rather use relatively simple distinctions (e.g. stable versus unstable osteochondritis dissecans; lateral wall intact versus not intact), as these are more reliable.
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Affiliation(s)
- Rens Bexkens
- Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Rens Bexkens, Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA.
| | - F. Joseph Simeone
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Luke S Oh
- Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ciccotti MC, Ciccotti MG. Exam and Imaging of the Throwing Elbow. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150732] [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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16
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Long-Term Outcomes of Arthroscopic Debridement With or Without Drilling for Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players: A ≥10-Year Follow-Up Study. Arthroscopy 2020; 36:1273-1280. [PMID: 32001276 DOI: 10.1016/j.arthro.2020.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of arthroscopic debridement for capitellar osteochondritis dissecans (OCD) in adolescent baseball players. METHODS This retrospective study evaluated clinical outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players seen between 2003 and 2006. Inclusion criteria were at least 10 years of follow-up after surgery. Exclusion criteria were previous elbow surgery and age <12 years or >19 years. Patients were examined for presence of pain, inflammation (effusion), and range of motion. Outcome measures were determined using Timmerman/Andrews scores. Defect severity on preoperative radiographs was classified into 3 grades: small, moderate, and large. Return to baseball, pre- and postoperative range of motion and Timmerman/Andrews elbow score were evaluated according to defect severity. RESULTS Twenty-three elbows of 23 baseball players (mean age, 14.7 [range, 13-17] years) underwent arthroscopic debridement for capitellar OCD. Mean follow-up duration was 11.5 (range, 10-13) years. Twenty patients (87%) returned to competitive baseball at their preoperative level; of these, 15 were non-pitchers and returned to the same position but only 1 of 5 pitchers returned to playing pitcher. One patient with a large defect and drilling underwent reoperation 11 years after the initial operation. Mean change in extension was 4.3° and that in flexion was 3.7°. Timmerman/Andrews score improved significantly from 160 (95% confidence interval 146.7-173.3) to 195 (95% confidence interval 185.2-204.8) at the most recent follow-up (P ˂ .0001). Osteochondral defects detected on preoperative radiographs were small in 10 patients, moderate in 7, and large in 6. There was no significant between-group difference in extension, flexion, or Timmerman/Andrews score preoperatively or at the most recent follow-up. CONCLUSIONS Arthroscopic debridement with or without drilling allowed return to play in adolescent baseball players for positions other than pitchers. Long-term outcomes are likely durable regardless of lesion size. LEVEL OF EVIDENCE Level IV, Case series.
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Feldman MD. Editorial Commentary: Should We Consider Early Retirement for Adolescent Pitchers and Catchers With Osteochonditis Dissecans of the Capitellum? Arthroscopy 2020; 36:1281-1282. [PMID: 32370890 DOI: 10.1016/j.arthro.2020.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
Repetitive throwing in the adolescent athlete often leads to long-term problems. Strict pitch counts and limitation of pitches (e.g., curve balls) that place extreme stress on the immature elbow must be monitored closely. And until our outcomes for osteochondritis dissecans of the capitellum in adolescent baseball players improve, it may be wise to counsel those pitchers and catchers who are symptomatic to consider switching to another position or sport.
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Chen E, Pandya NK. Failure of Surgery for Osteochondral Injuries of the Elbow in the Pediatric and Adolescent Population. Curr Rev Musculoskelet Med 2020; 13:50-57. [PMID: 31950429 DOI: 10.1007/s12178-020-09606-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW With an increase in single-sport specialization, elbow injuries have become increasingly common in the pediatric and adolescent population. Osteochondritis dissecans (OCD) of the capitellum frequently requires intervention yet can be difficult to treat given high patient activity demands. The purpose of this paper is to review treatment options, understand failure rates, and provide strategies for successful revision surgery. RECENT FINDINGS Patients at high risk for the development of this condition are involved in high-demand upper extremity activity such as baseball or gymnastics. Treatment options include non-operative management, drilling, fixation, loose body removal/microfracture, osteochondral autograft, and osteochondral allograft. Cartilage preservation procedures (i.e., osteochondral autograft) have a significant advantage in terms of clinical and radiographic healing compared with fixation or microfracture. Capitellar OCD lesions afflict a large number of adolescent athletes today and will likely continue increasing in number from sports-related injuries. It is critical to recognize and treat these lesions in a timely and appropriate fashion to optimize clinical outcomes. When faced with failure of healing, surgeons must critically analyze reasons for failure including post-operative compliance, return to high-demand sporting activity, fixation of non-viable fragments, utilization of microfracture, alignment, and concomitant pathology.
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Affiliation(s)
- Eric Chen
- San Francisco Orthopedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA
| | - Nirav K Pandya
- Department of Orthopedic Surgery, Benioff Children's Hospital, University of California San Francisco, 747 52nd Street, Oakland, CA, 94609, USA.
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Matsuura T, Hashimoto Y, Kinoshita T, Nishino K, Nishida Y, Takigami J, Katsuda H, Shimada N. Donor Site Evaluation After Osteochondral Autograft Transplantation for Capitellar Osteochondritis Dissecans. Am J Sports Med 2019; 47:2836-2843. [PMID: 31503508 DOI: 10.1177/0363546519871064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral autograft transplantation (OAT) for capitellar osteochondritis dissecans (OCD) requires harvesting of tissue from the asymptomatic knee joint. However, donor site morbidity (DSM) in such cases remains unclear. PURPOSE To evaluate DSM and postoperative radiographic findings in patients undergoing OAT for advanced capitellar OCD. STUDY DESIGN Case series; Level of evidence, 4. METHODS Eighty-six juvenile athletes underwent OAT for advanced capitellar OCD. The 2000 International Knee Documentation Committee subjective score, rate of return to sports, and symptoms in the donor knee were assessed at a mean follow-up of 86 months (range, 28-185 months). Additionally, 49 of the 86 patients were assessed by radiographic and magnetic resonance imaging (MRI) findings of the knee donor site. DSM was defined according to the usual criterion (persistent symptoms for >1 year or the need for subsequent intervention) and a stricter criterion (the presence of any symptoms, such as effusion, patellofemoral complaints, crepitation, unspecified disturbance, stiffness, pain/instability during activities, and osteoarthritic change). The stricter criterion was also used to allocate patients into a DSM group and a no-DSM group. RESULTS Two and 11 patients were determined to have DSM according to the usual and stricter criteria, respectively. All patients returned to the competitive level of their sports. The mean International Knee Documentation Committee score was 99.0. MRI findings showed abnormal signal intensity in 17 patients (35%) and hypertrophic changes in 11 patients (22%) at the donor harvest sites. The MOCART (magnetic resonance observation of cartilage repair tissue) score was higher in the no-DSM group (mean, 68.2) than in the DSM group (mean, 52.9) (P = .027). CONCLUSION OAT for juvenile athletes with advanced capitellar OCD provided good clinical outcomes. The DSM rate was relatively low (2.3%) with the usual criterion but high (12.8%) with the stricter criterion. MRI showed an abnormal signal intensity and hypertrophy in some cases.
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Affiliation(s)
- Takeshi Matsuura
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
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Koda H, Moriya K, Ueki M, Endo N, Yoshizu T. Long-term results of closed-wedge osteotomy of the lateral humeral condyle for osteochondritis dissecans of the capitellum. J Shoulder Elbow Surg 2019; 28:e313-e320. [PMID: 31326338 DOI: 10.1016/j.jse.2019.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various surgical methods are used for osteochondritis dissecans of the capitellum; however, we have consistently performed a closed-wedge osteotomy of the lateral humeral condyle since 1983. The purpose of this study is to clarify the long-term results of closed-wedge osteotomy for osteochondritis dissecans of the capitellum. METHODS Seventy-seven elbows with all lesion types of osteochondritis dissecans of the capitellum were treated with closed-wedge osteotomy. Unstable osteochondral fragments were fixed with a bone graft and bone pegs in combination with osteotomy. The mean age of the patients was 14.0 years. The patients were clinically and radiographically evaluated at a median value of 9.0 years after surgery. RESULTS The range of elbow motion and standard deviation were increased significantly from 119° ± 22° preoperatively to 131° ± 18° postoperatively (P < .001). The Timmerman and Andrews score were improved significantly from 141 ± 26 points preoperatively to 184 ± 21 points postoperatively (P < .001). The Timmerman and Andrews score and the range of elbow motion at final examination in patients with preoperative osteoarthritic changes were significantly inferior to those in patients without preoperative osteoarthritic changes. Good remodeling of the capitellar lesions was radiographically observed in 53 elbows (69%). In the long-term follow-up evaluation, although 41 elbows (53%) had advanced osteoarthritic changes that were classified as grade II or III, disease progression was controlled in most of these cases. CONCLUSIONS Good or excellent long-term clinical results were maintained in most of our patients. Closed-wedge osteotomy of the lateral humeral condyle is a useful method that can provide acceptable long-term clinical results.
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Affiliation(s)
- Hisao Koda
- Department of Orthopaedic Surgery, Nagaoka Red Cross Hospital, Nagaoka City, Niigata, Japan.
| | - Koji Moriya
- Niigata Hand Surgery Foundation Hospital, Seiromachi, Niigata, Japan
| | - Masato Ueki
- Department of Orthopaedic Surgery, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Naoto Endo
- Department of Orthopaedic Surgery, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Takae Yoshizu
- Niigata Hand Surgery Foundation Hospital, Seiromachi, Niigata, Japan
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Osteochondrale Läsionen am Ellbogen. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-0288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kessler JI, Jacobs JC, Cannamela PC, Weiss JM, Shea KG. Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents. Orthop J Sports Med 2018; 6:2325967118815846. [PMID: 30622996 PMCID: PMC6302285 DOI: 10.1177/2325967118815846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known. Purpose To assess the demographics and epidemiology of OCD of the elbow among children. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group. Results A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females (P < .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups. Conclusion In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.
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Affiliation(s)
| | - John C Jacobs
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | - Jennifer M Weiss
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Kevin G Shea
- Department of Orthopaedics, Stanford University, Stanford, California, USA
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Funakoshi T, Momma D, Matsui Y, Kamishima T, Matsui Y, Kawamura D, Nagano Y, Iwasaki N. Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings. Am J Sports Med 2018; 46:1943-1951. [PMID: 29738680 DOI: 10.1177/0363546518768279] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. PURPOSE To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). RESULTS Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. CONCLUSION Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.
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Affiliation(s)
- Tadanao Funakoshi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.,Arthroscopic Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Daisuke Momma
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yusuke Nagano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Sato K, Iwamoto T, Matsumura N, Suzuki T, Nishiwaki Y, Oka Y, Nakamura T. Costal Osteochondral Autograft for Advanced Osteochondritis Dissecans of the Humeral Capitellum in Adolescent and Young Adult Athletes: Clinical Outcomes with a Mean Follow-up of 4.8 Years. J Bone Joint Surg Am 2018; 100:903-913. [PMID: 29870440 DOI: 10.2106/jbjs.17.01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The purpose of this study was to clarify longer-term clinical outcomes of costal osteochondral autografts in the treatment of advanced osteochondritis dissecans of the humeral capitellum. METHODS Seventy-two patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up, 57 months; range, 36 to 147 months). The mean patient age was 14.3 years. Clinical outcomes, including elbow range of motion, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated. RESULTS The mean elbow range of extension/flexion increased significantly, from -21°/122° preoperatively to -4°/136° postoperatively (p < 0.001). The mean clinical rating score improved significantly, from 101 to 190 by the latest follow-up (p < 0.001). The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3. Seventy of the 72 patients returned to their original sport. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results. CONCLUSIONS Costal osteochondral autograft successfully achieved anatomical and biological reconstruction in the treatment of advanced osteochondritis dissecans of the humeral capitellum. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kazuki Sato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | | | - Toshiyasu Nakamura
- Clinical Research Center, International University of Health and Welfare, Tokyo, Japan
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Matsui Y, Funakoshi T, Momma D, Miyamoto A, Endo K, Furushima K, Fujisaki K, Iwasaki N. Variation in stress distribution patterns across the radial head fovea in osteochondritis dissecans: predictive factors in radiographic findings. J Shoulder Elbow Surg 2018; 27:923-930. [PMID: 29477668 DOI: 10.1016/j.jse.2017.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/12/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Predictive factors for the development of osteoarthritis in adolescent osteochondritis dissecans (OCD) of the humeral capitellum remain unclear. The objectives of this study were to assess subchondral bone density in the radial head fovea of patients with OCD and to evaluate stress distribution in the radiocapitellar joint. The relationship between radiologic classification and stress distribution, according to multivariate ordinal regression analysis, was also investigated. METHODS Computed tomography (CT) imaging data from 54 male patients with OCD (mean age, 13.1 years) were collected. Stress in the radial head fovea was measured using CT osteoabsorptiometry. A stress map was constructed and divided into 4 sections, and percentages of high-density regions in each section were quantitatively analyzed. Multivariate ordinal regression analyses were performed of bone density, incorporating the stage, location, and size of the OCD lesion and the presence of medial elbow disturbance in the radiographic images. RESULTS The percentage of high-density area in the anteromedial, posteromedial, and the anterolateral sections of the radial head fovea were significantly increased compared with the posterolateral section. Multivariate ordinal regression analysis revealed that the location and size of the lesion and a history of excessive valgus stress were associated with imbalances in the radial head fovea. CONCLUSIONS When the OCD lesion is large and located laterally and a medial epicondyle disturbance is apparent on radiographs, the risk for developing advanced radiocapitellar osteoarthritis should be considered. These findings can be useful in the decision-making process for treating OCD.
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Affiliation(s)
- Yuki Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan.
| | - Daisuke Momma
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Kaori Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kozo Furushima
- Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Kazuhiro Fujisaki
- Department of Intelligent Machines and System Engineering, Hirosaki University Graduate School of Science and Technology, Hirosaki, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Oshiba H, Itsubo T, Komatsu M, Uchiyama S, Kato H. Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players. JBJS Essent Surg Tech 2018; 8:e8. [PMID: 30233980 DOI: 10.2106/jbjs.st.17.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Capitellar osteochondritis dissecans (OCD) is a focal injury of the articular cartilage involving separation of a segment of cartilage from the subchondral bone that is infrequently encountered in the dominant-side elbow of adolescent throwing athletes1,2. The literature suggests that patients may achieve better short and mid-term results when treated with certain types of surgical procedures3,4. Selection of the appropriate surgical method should be based on the International Cartilage Repair Society (ICRS) OCD classification system5. For lesions involving ≤50% of the surface area of the capitellum, debridement with microfracture and/or loose body removal have shown excellent results. For lesions involving >50% of the surface area of the capitellum and classified as ICRS OCD III or IV, autologous osteochondral grafting may be the most suitable treatment6-8. Bone peg grafting (BPG) has been shown to be an effective treatment option for early-stage capitellar OCD that can preserve the local hyaline cartilage9,10. Description Using direct vision and with arthroscopy, the continuity of the capitellar surface and the stability of the capitellar lesion were evaluated according to the ICRS OCD classification5. BPG was indicated for adolescents with ICRS OCD I or II. The elbow was opened between the extensor carpi ulnaris and the anconeus muscle (Kocher interval). Another skin incision of 3 cm in length was made at the posterior aspect of the metaphysis of the ipsilateral olecranon. Three, 4, or 5 bone pegs of approximately 20 mm in length were harvested from the posterior ulnar cortex. A Kirschner wire of 3 mm in diameter was used for drilling holes in the lesion, and then the bone pegs were inserted with tweezers to a depth of 10 mm. Next, a flat-surfaced rod was placed on the head of each bone peg to press it to a depth slightly lower than the articular cartilage surface. Postoperatively, the elbow was immobilized for 3 weeks. Throwing was allowed at 6 months, and a return to competitive baseball at preinjury levels was permitted at 8 months after BPG. Alternatives Arthroscopic debridement of the lesion.Arthroscopic bone marrow stimulation or microfracture.Fragment fixation using metal implants or biodegradable materials.Use of autologous osteochondral graft from the distal aspect of the femur or from a rib. Rationale Our follow-up study after BPG revealed that 10 of 11 patients with ICRS OCD I or II capitellar OCD could return to their preinjury baseball ability and that 8 of the 11 lesions completely healed as seen radiographically11. Radiographic and magnetic resonance imaging (MRI) findings showed that BPG could secure the lesion to the osseous floor as a physiological scaffold. Fragment fixation with metal implants or biodegradable materials carries a risk of damaging cartilage surfaces, and autologous osteochondral grafting is too invasive for this early-stage lesion. BPG is indicated for ICRS OCD I or II lesions, especially with central positioning and/or occupying <75% of the size of the capitellum in the coronal plane11.
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Affiliation(s)
- Hiroyuki Oshiba
- Marunouchi Hospital, Matsumoto, Japan.,Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshiro Itsubo
- Sports Medicine Center, Aizawa Hospital, Matsumoto, Japan
| | - Masatoshi Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Lu Y, Li YJ, Guo SY, Zhang HL. Is there any difference between open and arthroscopic treatment for osteochondritis dissecans (OCD) of the humeral capitellum: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:601-607. [DOI: 10.1007/s00264-018-3768-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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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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Matsuura T, Hashimoto Y, Nishino K, Nishida Y, Takahashi S, Shimada N. Comparison of Clinical and Radiographic Outcomes Between Central and Lateral Lesions After Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Humeral Capitellum. Am J Sports Med 2017; 45:3331-3339. [PMID: 28968135 DOI: 10.1177/0363546517730358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical studies have reported satisfactory results after osteochondral autograft transplantation (OAT) for central lesions of unstable osteochondritis dissecans (OCD) of the elbow. However, the outcomes after OAT for lateral lesions remain unclear. HYPOTHESIS The clinical outcomes of OAT would be better for central lesions than for lateral lesions. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors retrospectively evaluated 103 juvenile athletes (mean age, 13.2 years; range, 11-16 years) who underwent OAT for symptomatic OCD of the humeral capitellum from 2003 to 2014. Sixteen patients were excluded because they did not fit the inclusion criteria. The final cohort of 87 patients was divided by lesion type into central lesion (n = 43) and lateral lesion (n = 44) groups. When possible, a single large plug was created for grafting and trimmed to reconstruct the rounded joint surface. The clinical, radiographic, and magnetic resonance imaging outcomes were evaluated for each group at a mean follow-up of 43 months (range, 24-100 months). RESULTS There were no significant differences in the age, sex, height, weight, duration of symptoms, follow-up time, preoperative range of motion, or Timmerman and Andrews score between the 2 groups. The preoperative osteoarthritic changes (0 of 43 for central vs 5 of 44 cases for lateral; P = .023), mean lesion size (12.2 ± 2.9 vs 18.2 ± 7.0 mm; P < .001), and graft number (1.6 vs 2.8; P < .001) were significantly greater in the lateral group versus the central group. The mean range of extension (2.3° ± 5.4° vs -3.2° ± 8.7°; P < .001) and Timmerman and Andrews score (194 vs 185; P = .006) at the final follow-up were significantly better for patients in the central group. More patients in the lateral group had postoperative radial head subluxation (0 of 43 vs 6 of 44; P = .012) and osteoarthritic changes (1 of 43 vs 9 of 44; P = .008). The mean MOCART score showed no significant differences between the groups (78.0 ± 15.7 vs 72.6 ± 20.9; P = .181). The rate of return to sports at the previous level was 100% in the central group and 86% in the lateral group ( P = .012). CONCLUSION The clinical and radiographic outcomes after OAT associated with unstable OCD of the humeral capitellum were better for central lesions than for lateral lesions. However, satisfactory outcomes and a high rate of return to sports were obtained for unstable lateral lesions after OAT.
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Affiliation(s)
- Takeshi Matsuura
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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Maruyama M, Satake H, Suzuki T, Honma R, Naganuma Y, Takakubo Y, Takagi M. Comparison of the Effects of Osteochondral Autograft Transplantation With Platelet-Rich Plasma or Platelet-Rich Fibrin on Osteochondral Defects in a Rabbit Model. Am J Sports Med 2017; 45:3280-3288. [PMID: 28853913 DOI: 10.1177/0363546517721188] [Citation(s) in RCA: 18] [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
BACKGROUND Although osteochondral autograft transplantation (OAT) provides satisfactory outcomes for osteochondral defects, for large defects OAT is often inadequate because of graft availability. Osteochondral allograft transplantation is an alternative treatment for large defects, but this approach is limited by graft storage constraints and carries disease transmission risks. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate, and its positive effect on articular cartilage has been reported. However, the effect of PRF with OAT of osteochondral defects is unknown. PURPOSE To compare the effects of OAT with platelet-rich plasma (PRP) and PRF on osteochondral defects in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Forty-two juvenile rabbits were divided into control, PRP, and PRF groups. In the control and PRP groups, a cylindrical osteochondral defect (5 mm in diameter and 2 mm in depth) was created on the patellar groove, and an osteochondral graft (3.5 mm in diameter and 5 mm in length) harvested from the contralateral side was inserted into the distal portion of the defect. After wound closure, either normal saline or PRP was injected in the knee. In the PRF group, a PRF clot was placed in the defect before grafting. The surgical site was macroscopically and histologically assessed after 3 and 12 weeks. RESULTS At 3 weeks, the PRF group (n = 8) was macroscopically healed compared with the other 2 groups (control, n = 7; PRP, n = 6) ( P < .005). Histologically, osteochondral graft cartilage of the PRF group had normal cellularity and higher amounts of safranin O staining relative to the other 2 groups ( P < .005). At 12 weeks, all 3 groups (n = 8 per group) were macroscopically healed with normal or nearly normal cartilage, and osteochondral graft cartilage was histologically hyaline cartilage. In contrast, the PRF group healed with hyaline-like cartilage at nongrafted defects, whereas the other 2 groups healed with fibrocartilage ( P < .001). CONCLUSION OAT with PRF maintained hyaline cartilage, and the nongrafted defect healed with hyaline-like cartilage. CLINICAL RELEVANCE PRF has the potential to improve clinical outcomes of OAT used to treat osteochondral lesions.
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Affiliation(s)
- Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoto Suzuki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuya Takakubo
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Shimada K, Temporin K, Oura K, Tanaka H, Noguchi R. Anconeus Muscle-Pedicle Bone Graft With Periosteal Coverage for Osteochondritis Dissecans of the Humeral Capitellum. Orthop J Sports Med 2017; 5:2325967117727531. [PMID: 28944252 PMCID: PMC5602222 DOI: 10.1177/2325967117727531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: Treatment of advanced osteochondritis dissecans (OCD) of the capitellum is controversial, especially in moderate-sized lesions. Purpose: To establish a treatment algorithm for capitellum OCD, we tried to determine the utility of and problems associated with anconeus muscle-pedicle bone graft with periosteal coverage (ABGP) for the treatment of moderate-sized articular OCD defects of the capitellum. Study Design: Case series; Level of evidence, 4. Methods: According to our protocol for elbow OCD, 16 patients (15 males, 1 female; age range, 12-17 years; mean age, 14.4 years) with a moderate-sized OCD lesion of the humeral capitellum were treated with ABGP. All patients had a full-thickness, unstable OCD lesion that was 10 to 15 mm in diameter. Clinical results and postoperative images, including radiographs and magnetic resonance imaging (MRI), were evaluated at a mean follow-up of 31 months (range, 24-66 months). Results: All but 1 patient had functional improvement after the procedure and returned to previous sporting activities within 6 months. One female patient needed 1 year for functional recovery due to development of postoperative chronic regional pain syndrome (CRPS). Two patients required additional surgery, including shaving of the protruding cartilage, and they returned to their previous level of activity. Mean arc of range of flexion-extension motion was 117° preoperatively and 129° at follow-up (P = .031). Mean elbow function as assessed with the clinical rating system of Timmerman and Andrews was 136 preoperatively and 186 at follow-up (P = .00012). Bony union of the graft as demonstrated by trabecular bone bridging on radiography was obtained within 3 months in all patients. Postoperative MRI was examined for 14 patients at 6 to 12 months after the procedure; the MRIs showed near-normal articular surface integrity in 9 of the 14 patients (64%) and underlying bony structure in 10 of the 14 patients (71%). Conclusion: Improvement after ABGP was obtained within 6 months in all except 1 patient, who developed CRPS. Postoperative radiography and MRI revealed near-normal articular surface integrity or underlying bony structure. This procedure is useful as a surgical option for a moderate-sized articular OCD lesion in the elbow.
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Affiliation(s)
- Kozo Shimada
- Department of Emergency/Sports Medicine, JCHO Osaka Hospital, Osaka, Japan
| | - Ko Temporin
- Department of Orthopaedic Surgery, JCHO Osaka Hospital, Osaka, Japan
| | - Keiichiro Oura
- Department of Orthopaedic Surgery, JCHO Osaka Hospital, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryosuke Noguchi
- Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
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Kameda Y, Funakoshi T, Takeuchi S, Sugawara K, Iwasaki N. Viability of Cells From Displaced Fragments of the Elbow Osteochondritis Dissecans: Alternative Source of Autologous Chondrocyte Implantation. Arthroscopy 2017; 33:291-296.e1. [PMID: 27956231 DOI: 10.1016/j.arthro.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the histological properties of cells from displaced fragments obtained from patients with advanced osteochondritis dissecans (OCD) of the elbow and to examine whether these displaced fragments could be used as cell sources for autologous chondrocyte implantation. METHODS We harvested 6 displaced fragments from 6 patients who underwent osteochondral mosaicplasty for OCD of the elbow. The displaced fragments were examined histologically and digested to obtain chondrocytes. The cells obtained from young patients and skeletally matured cadaveric donors were examined using quantitative reverse transcription polymerase chain reaction analysis to quantify the expression of chondrocyte marker genes. The cells were cultured in atelocollagen, and the properties of 3-dimensional cultured cartilage were examined. RESULTS All 6 displaced fragments contained hyaline cartilage tissue. Chondrocyte marker genes were examined using cells from only 4 patients, because we obtained enough cells in only 4 patients. The relative expression levels of aggrecan, type II, Sox 9 were 2.61, 4.03, and 1.71, respectively. Three-dimensional cultured cartilage from all 6 displaced fragments contained 62.0 pg/cell (range, 22.8-91.3 pg/cell) of glycosaminoglycan and expressed type II collagen in the superficial and middle layer. CONCLUSIONS The chondrocytes obtained from the displaced fragments remained viable and exhibited chondrogenic features. These cells may potentially be a cell source of autologous chondrocytes implantation. CLINICAL RELEVANCE We have shown that displaced fragments from OCD of the elbow have potential for a cell source for generating 3-dimensional cultured cartilage.
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Affiliation(s)
- Yusuke Kameda
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | | | | | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Autologous chondrocyte implantation for post-traumatic cartilage defect of the capitulum humeri. J Shoulder Elbow Surg 2016; 25:e213-6. [PMID: 27283373 DOI: 10.1016/j.jse.2016.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/20/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
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Funakoshi T, Furushima K, Momma D, Endo K, Abe Y, Itoh Y, Fujisaki K, Tadano S, Iwasaki N. Alteration of Stress Distribution Patterns in Symptomatic Valgus Instability of the Elbow in Baseball Players: A Computed Tomography Osteoabsorptiometry Study. Am J Sports Med 2016; 44:989-94. [PMID: 26831631 DOI: 10.1177/0363546515624916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Repetitive valgus stress applied during a throwing motion can lead to various elbow disturbances, including ulnar collateral ligament (UCL) injury. Subchondral bone density reportedly reflects the cumulative force on a joint surface under actual loading conditions. PURPOSE (1) To evaluate the distribution of subchondral bone density across the elbow joint in asymptomatic baseball pitchers and symptomatic valgus instability pitchers and (2) to clarify the alterations in stress distribution pattern associated with symptomatic UCL insufficiency pitching activities. STUDY DESIGN Controlled laboratory study. METHODS Computed tomography (CT) imaging data were collected from the dominant-side elbow of 7 nonathletic volunteers (controls), 12 asymptomatic pitchers (asymptomatic group), and 12 symptomatic valgus instability pitchers with UCL insufficiency (symptomatic group). Bone mineral density across the elbow joint was measured with CT osteoabsorptiometry. A 2-dimensional mapping model was divided into 4 areas of the distal end of the humerus and 5 areas of the ulna with the radial head. The locations and percentages of high-density areas on the articular surface were quantitatively analyzed. RESULTS High-density areas in the asymptomatic and symptomatic groups were found in the anterolateral and posteromedial parts of the humerus and in the radial head, posteromedial to the ulna. The high-density areas in the anterior and posteromedial of the humerus, the radial head, and the posteromedial part of the ulna in the controls were smaller than those in the baseball group. In the symptomatic group, the percentages of high-density areas in the anterolateral part of the humerus (mean, 36.3%; 95% CI, 31.9%-40.7%) and the anterolateral part of the ulna (mean, 31.7%; 95% CI, 24.3%-39.1) were significantly greater than those in the asymptomatic group (P = .047 and P < .0001, respectively). CONCLUSION Symptomatic UCL insufficiency was associated with characteristic high-stress distribution patterns on the anterolateral part of the capitellum and the anterolateral part of the ulna. The current results indicate that symptomatic UCL insufficiency produces excessive and cumulative stress in the elbow joint. CLINICAL RELEVANCE The information obtained from the CT images can useful for early detection of overstress conditions of the elbow joint.
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Affiliation(s)
- Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Daisuke Momma
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kaori Endo
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Kazuhiro Fujisaki
- Department of Intelligent Machines and System Engineering, Hirosaki University Graduate School of Science and Technology, Hirosaki, Japan
| | - Shigeru Tadano
- Division of Human Mechanical Systems and Design, Hokkaido University Graduate School of Engineering, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Fresh Osteochondral Allograft Transplantation for the Treatment of Unstable Osteochondritis Dissecans of the Capitellum in the Elbow. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vezeridis AM, Bae DS. Evaluation of Knee Donor and Elbow Recipient Sites for Osteochondral Autologous Transplantation Surgery in Capitellar Osteochondritis Dissecans. Am J Sports Med 2016; 44:511-20. [PMID: 26712891 DOI: 10.1177/0363546515620184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral autologous transplantation surgery (OATS) has been advocated for treatment of osteochondritis dissecans (OCD) of the capitellum in adolescents. However, little information is available regarding the optimal knee harvest site to match the contour and cartilage thickness of the recipient elbow lesion. PURPOSE To characterize the capitellar anatomic structure in adolescents with and without OCD and to compare these measurements to normal adolescent knees to identify the optimal site for osteochondral graft harvest. STUDY DESIGN Controlled laboratory study. METHODS Twenty-one patients with OCD were analyzed. Twenty-two patients with normal elbows and 25 age-, weight-, and height-matched patients with normal knees were also identified. Cartilage radii of curvatures (ROCs) in the sagittal and coronal-axial planes were measured on magnetic resonance imaging (MRI) of normal capitella and 5 sites (posterior lateral femoral condyle, medial and lateral middle trochlear ridges, and medial and lateral inferior trochlear ridges) in normal knees. Differences in ROC between the knee donor and capitellar recipient sites were calculated based on a 10-mm osteochondral plug diameter. RESULTS Overall, the mean apex differences between graft and recipient sites ranged from 0.4 to 0.9 mm, and mean edge differences ranged from 0.5 to 1.4 mm in the coronal-axial dimension. Of all knee sites tested, the posterior lateral femoral condyle had average ROCs (19.1 mm sagittal; 14.1 mm axial) most like the capitellum (10.6 mm sagittal, 12.6 mm coronal-axial), resulting in minimal apex and edge differences (apex difference = -0.6 mm; coronal-axial side difference = -0.5 mm; no sagittal side difference). Of the anterior nonweightbearing sites, the inferior medial trochlear ridge (28.3 mm sagittal ROC; 13.2 mm coronal-axial ROC) demonstrated the lowest apex and side differences when compared with the capitellum (apex difference = -0.8 mm; coronal-axial side difference = -0.8 mm; no sagittal side difference). The frequently used middle lateral trochlear ridge (28.8 mm sagittal; 8.7 mm coronal-axial ROCs) had the largest side difference (apex distance = -0.8 mm; coronal-axial side difference = -1.4 mm; no sagittal side difference). CONCLUSION/CLINICAL RELEVANCE In cases where a large single-plug OATS is considered, a 10-mm plug from the anterior nonweightbearing aspect of the distal femur is calculated to result in ≤1 mm of articular incongruity at the recipient capitellum. The inferior medial trochlear ridge should be considered as a donor site for OATS procedures for OCD given its accessibility and favorable geometry.
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Affiliation(s)
- Alexander M Vezeridis
- Department of Radiology, University of California at San Diego, San Diego, California, USA
| | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
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Takeba J, Takahashi T, Watanabe S, Imai H, Kikuchi S, Umakoshi K, Matsumoto H, Ohshita M, Miura H, Aibiki M. Short-term clinical results of arthroscopic osteochondral fixation for elbow osteochondritis dissecans in teenaged baseball players. J Shoulder Elbow Surg 2015; 24:1749-56. [PMID: 26480880 DOI: 10.1016/j.jse.2015.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reports regarding arthroscopic fixation of the osteochondral fragments for elbow osteochondritis dissecans (OCD) are few. This study assessed the clinical outcomes of arthroscopic fixation of unstable osteochondral fragments by using absorbable pins over a postoperative period of at least 1 year. METHODS The patients were 13 adolescent baseball players with a mean age of 14 years (range, 12-16 years) who underwent OCD of primary lesions at International Cartilage Repair Society grades III and IV. The patients were evaluated by using validated outcome measures at a mean follow-up period of 24 months (range, 12-50 months). RESULTS The mean (standard deviation) score in the disability/symptom section of the Disabilities of the Arm, Shoulder, and Hand improved from 12.4 (6.0) before the surgery to 0.5 (1.2) after the surgery, and the sports section improved from 74.5 (25.4) to 1.4 (5.2). The mean (standard deviation) extension improved from -11° (10.8) to -2° (3.9; P < .001). The mean (SD) flexion improved from 129° (11.6) to 137° (5.6; P = .040). All patients were able to resume playing baseball, and 9 (69%) resumed playing at the same position as before their injuries. CONCLUSIONS The clinical results of arthroscopic osteochondral fragment fixation in the teenaged baseball players with elbow OCD, albeit obtained over only a short period, were favorable. This arthroscopic treatment enables repair of lesions and is considered appropriate for unstable OCD during the adolescent growth spurt.
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Affiliation(s)
- Jun Takeba
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | | | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Satoshi Kikuchi
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | - Kensuke Umakoshi
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | | | - Muneaki Ohshita
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Mayuki Aibiki
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
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Gancarczyk SM, Makhni EC, Lombardi JM, Popkin CA, Ahmad CS. Arthroscopic Articular Reconstruction of Capitellar Osteochondral Defects. Am J Sports Med 2015; 43:2452-8. [PMID: 26272515 DOI: 10.1177/0363546515594448] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular reconstruction is recommended for some unstable capitellar osteochondritis dissecans (OCD) lesions. Capitellar osteochondral autograft transplantation (OAT) through an open approach for optimal visualization and perpendicular graft implantation has been advocated. However, arthroscopic capitellar OAT may achieve the same treatment goals with decreased morbidity and ability to treat the entire joint for pathologic changes. PURPOSE/HYPOTHESIS The purpose of this study was to assess the ability to resurface the capitellum arthroscopically. The hypothesis was that arthroscopy allows sufficient access to facilitate perpendicular graft placement in most clinically significant capitellar OCD lesions. STUDY DESIGN Descriptive laboratory study. METHODS Arthroscopy was performed on 12 fresh-frozen cadaveric elbows. Of the tunnels created, 21 were used in final analysis. A 6-mm osteochondral transplantation bone graft harvester was used to generate perpendicular recipient sites in the capitellar articular surface. Both central (n = 11) and lateral (n = 10) OCD locations were studied. Fluoroscopy was used to measure the angle of the harvest relative to the axis of the humerus and tunnel perpendicularity. RESULTS Among central and lateral lesions, the average (±SD) degree of perpendicularity achieved was 85.3° ± 2.9° and 85.8° ± 2.5°, respectively. Perpendicular harvests were achieved in central and lateral lesions as high as 74.9° and 80.4°, anterior to the humeral shaft, respectively. No significant relationship was noted between increasing anterior location and ability to attain perpendicular harvests. Achieving perpendicularity in lesions that were more anterior to these values was not possible due to anatomic constraints of the radial head in maximal elbow flexion. CONCLUSION Adequate recipient tunnels were created in lesions that were as high as 75° to 80° anterior to the humeral shaft, which encompasses most clinically relevant lesions. Moreover, increasing the anterior position of the lesion did not compromise the ability to generate perpendicular tunnels. The findings of this cadaveric study suggest that most clinically relevant capitellar osteochondral lesions can be successfully resurfaced arthroscopically. CLINICAL RELEVANCE This study demonstrates the feasibility of performing an arthroscopic versus open articular reconstruction when indicated for high-grade capitellar OCD lesions. These conclusions afford sports medicine surgeons another tool in the treatment of this challenging condition.
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Affiliation(s)
| | - Eric C Makhni
- Columbia University Medical Center, New York, New York, USA
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Kodama N, Ueba H, Takemura Y, Ishida M, Imai S, Matsusue Y. Joint Arthroplasty With Osteochondral Grafting From the Knee for Posttraumatic or Degenerative Hand Joint Disorders. J Hand Surg Am 2015; 40:1638-45. [PMID: 26143968 DOI: 10.1016/j.jhsa.2015.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the operative procedure and report the clinical outcomes of articular surface reconstruction for various hand joint disorders using autologous osteochondral grafts from the knee. METHODS Ten patients underwent articular surface reconstruction for hand joint disorders with autologous osteochondral grafts from the patellofemoral joint. Mean patient age was 35 years (range, 15-52 y). The patients were followed for an average of 48 months (range, 16-89 mo). Arthroplasty was performed on the metacarpophalangeal joint in 4 cases, and on the proximal interphalangeal joint in 6 cases. The patients' clinical outcomes were evaluated with joint range of motion, visual analog scale (0-10 points), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Histological examination was performed in 3 cases after surgery. RESULTS Graft union was confirmed in all cases without radiographic evidence of resorption or necrosis. Follow-up radiographic examinations showed good graft incorporation without signs of osteoarthritis such as joint space narrowing. The finger flexion-extension arc improved significantly from an average of 21° to 61°. The mean visual analog scale also improved significantly from 7.0 to 1.5. The mean total active motion showed a significant improvement from 151° before surgery to 201° after surgery, and the mean DASH score improved significantly from 33 to 12. There were no significant differences for the arc of finger motion and DASH score between metacarpophalangeal and proximal interphalangeal joint disorders or between hemiarthroplasty and total joint arthroplasty. Histological examination revealed viable chondrocytes in the implanted cartilage. CONCLUSIONS Autologous osteochondral grafting from the patellofemoral joint provided satisfactory outcomes and may be a useful option for joint surface reconstruction of traumatic or degenerative hand joint disorders. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Narihito Kodama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Hiroaki Ueba
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshinori Takemura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mitsuaki Ishida
- Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshitaka Matsusue
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Lyons ML, Werner BC, Gluck JS, Freilich AM, Dacus AR, Diduch DR, Chhabra AB. Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes. J Shoulder Elbow Surg 2015; 24:1098-105. [PMID: 25958215 DOI: 10.1016/j.jse.2015.03.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/01/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the capitellum is a condition most commonly seen in adolescents involved in repetitive overhead sports and can profoundly affect ability to return to play and long-term elbow function. Treatment of large, unstable defects in the elbow with osteochondral autograft plug transfer has not been adequately studied. METHODS We retrospectively identified 11 teenaged patients with large (>1 cm(2)) capitellar OCD treated with osteochondral autograft plug transfer. Average age at the time of surgery was 14.5 years (range, 13-17 years). Outcome measures obtained included return to play, preoperative and postoperative elbow range of motion, Disabilities of Arm, Shoulder and Hand (DASH; Institute for Work and Health, Toronto, ON, Canada) by telephone interview, and osseous integration on radiographs. All 11 patients were available for evaluation at an average of 22.7 months (range, 6-49 months) postoperatively. RESULTS All patients were involved in competitive high school athletics and returned to at least their preinjury level of play. Average return to play was 4.4 months (range 3-7 months). The average final DASH was 1.4 (95% confidence interval, 0.6-2.1), and the average final sport-specific DASH was 1.7 (95% confidence interval -1.8 to 5.2). Elbow range of motion significantly improved, including improvement in flexion from a preoperative average of 126° to a postoperative average of 141° (P = .009) and improvement in extension from a preoperative average of 21° to a postoperative average of 5° (P = .006). CONCLUSIONS Treatment of large, unstable OCD lesions of the capitellum in adolescent athletes allows reliable return to play, is safe, and has good clinical outcomes at short-term follow-up.
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Affiliation(s)
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joshua S Gluck
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Aaron M Freilich
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - A Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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Shin JJ, Haro M, Yanke AB, Mascarenhas R, Romeo AA, Cole BJ, Inoue N, Verma NN. Topographic analysis of the capitellum and distal femoral condyle: finding the best match for treating osteochondral defects of the humeral capitellum. Arthroscopy 2015; 31:843-9. [PMID: 25636985 DOI: 10.1016/j.arthro.2014.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the donor zone of most congruent topographic match by comparing 4 donor sites from the femur with 4 potential recipient sites of osteochondritis dissecans at the capitellum. METHODS Computed tomography was performed on 5 right elbows and 6 right medial and 6 right lateral distal femoral hemicondyles, which included the femoral notch. Three-dimensional computed tomography models were created and exported into point-cloud models. A local coordinate map of the distal humerus and distal femoral articular surfaces was created. The capitellum was compared with the medial and lateral distal femoral condyles, with 2 donor zones in each condyle (medial trochlea and medial intercondylar notch or lateral trochlea and lateral intercondylar notch). In each capitellum 4 combinations of 10-mm defects were simulated (central and lateral, 30° and 45° anterior to shaft of humerus), resulting in 480 capitellum-femur comparative combinations being tested. The capitellum surfaces were virtually placed on a point on the femoral articular surface in 3-dimensional space. The least distances (i.e., the shortest distance from the point in question to the corresponding point in space) between the point clouds on the distal humerus and distal femoral articular surfaces were calculated. RESULTS There was a less than 0.1-mm difference in the topographic articular surface match among the 4 commonly used donor sites of the distal femur and 4 recipient sites of the capitellum. However, the best match for any given 10-mm capitellar defect (central 30°, central 45°, lateral 30°, and lateral 45°) was the same such that the lateral trochlea on the femur always yielded the best fit compared with the 3 other graft locations (P < .005). CONCLUSIONS Our results indicate that there is a less than 0.1-mm difference in the topographic articular surface match among the 4 commonly used donor sites of the distal femur and the capitellum. The findings suggest that all 4 donor sites provide close articular matching for the capitellum articular surface, with the lateral trochlea articular surface providing the best match. CLINICAL RELEVANCE These data suggest that a single donor plug may be obtained from multiple sites in the knee and placed into capitellar lesions with an excellent topographic articular surface match. The findings of our study will be useful to surgeons when managing capitellar osteochondritis dissecans lesions.
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Affiliation(s)
- Jason J Shin
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Marc Haro
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Randy Mascarenhas
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Uchida S, Utsunomiya H, Taketa T, Sakoda S, Hatakeyama A, Nakamura T, Sakai A. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate Acid thread pins for treating elbow osteochondritis dissecans. Am J Sports Med 2015; 43:1057-65. [PMID: 25737319 DOI: 10.1177/0363546515570871] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various procedures, such as arthroscopic debridement, osteochondral transplantation, and bone plug fixation, have been described for the treatment of osteochondritis dissecans (OCD) of the humeral capitellum. However, the use of hydroxyapatite/poly-L-lactate acid (HA/PLLA) thread pins to fix the osteochondral fragment in an OCD lesion is a recent development. HYPOTHESIS Adolescent throwing athletes would return to preinjury levels of function after arthroscopic osteochondral fragment fixation using HA/PLLA thread pins. STUDY DESIGN Case series; Level of evidence, 4. METHODS Enrolled in this prospective cohort study were 18 adolescent baseball players (mean age, 14.2 years; range 12-16, years) with elbow OCD who underwent arthroscopic fragment fixation with HA/PLLA thread pins between 2006 and 2009. All patients were affected on their dominant side. Plain radiographs taken before surgery showed an open physis in 13 patients (72%) and a closed physis in 5 patients (28%). During surgery, the condition of the OCD lesion was evaluated by use of the International Cartilage Research Society (ICRS) classification system; there were 5 grade II, 11 grade III, and 2 grade IV cases. Outcomes were assessed after 3 years (mean, 39 months; range, 36-50 months). Elbow function was measured using the Timmerman and Andrews score and the Mayo Elbow Performance Index. Return to sports activity was assessed as higher than preinjury, same level, lower level, or no return to sports. RESULTS The mean Timmerman and Andrews score improved significantly from 126.6±6.5 to 197.5±1.5, and the mean Mayo Elbow Performance Index improved significantly from 68.0±2.1 to 98.06±0.9 (P=.0001 for both). Mean elbow extension improved significantly from -10°±10.4° to -0.8°±5.2° (P=.006), and mean flexion improved significantly from 123.1°±17.9° to 138.6°±6.1° (P=.001). Three patients had a loss of extension greater than 5°. Five patients returned to a higher level of sports activity, 10 patients returned to the same level, and 2 patients returned to a lower level. A remaining patient did not return to baseball. In one patient, the lesion did not heal, resulting in fragmentation at 1 year after surgery. This patient consequently underwent revision arthroscopy to remove the lesion, and he eventually returned to sports at the same level of activity. CONCLUSION Arthroscopic fragment fixation using HA/PLLA thread pins provides a beneficial clinical outcome to adolescent baseball players with humeral capitellar OCD.
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Affiliation(s)
- Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomonori Taketa
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinsuke Sakoda
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihisa Hatakeyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshitaka Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Nishinaka N, Tsutsui H, Yamaguchi K, Uehara T, Nagai S, Atsumi T. Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum. J Shoulder Elbow Surg 2014; 23:1888-1897. [PMID: 25240513 DOI: 10.1016/j.jse.2014.06.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advanced-stage osteochondritis dissecans of the capitellum affecting the lateral wall may result in osteoarthritis, and suitable treatment is needed to avoid permanent deformation and impaired function. We aimed to assess postoperative outcomes of costal osteochondral autograft for treatment of this condition. METHODS We included 22 young overhead athletes (mean age, 13.9 years) with advanced osteochondritis dissecans of the humeral capitellum who underwent costal osteochondral autograft. All patients had elbow pain and wide-range articular cartilage lesions. We evaluated clinical and radiographic outcomes at a mean follow-up of 27 months (range, 12-77 months). RESULTS All patients achieved rapid functional improvement and returned to their former sports activity levels. The baseball players were able to play catch within 62 to 164 days (mean, 107 days) and returned to full pitching activity within 123 to 339 days (mean, 226 days). We assessed mean elbow function by the clinical rating system of Timmerman and Andrews and the Japanese Orthopaedic Association sports score; the scores improved from 121.5 and 53.7 points preoperatively to 169.2 points and 86.1 points, respectively, at the time of follow-up. Four patients required additional minor surgical procedures, including screw removal, loose body removal, and shaving off of spur formation. No patient showed obvious radiographic changes of osteoarthritis. All patients were satisfied with the final outcomes and had good functional recovery. CONCLUSION Costal osteochondral autograft gave satisfactory results for advanced osteochondritis dissecans of the humeral capitellum with extensive lesions affecting the lateral wall.
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Affiliation(s)
- Naoya Nishinaka
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Hiroaki Tsutsui
- Department of Orthopaedic Surgery and Sports Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Ken Yamaguchi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Taishi Uehara
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Suguru Nagai
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takashi Atsumi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
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Kolmodin J, Saluan P. Osteochondritis Dissecans of the Humeral Capitellum: The Significance of Lesion Location. Orthop J Sports Med 2014; 2:2325967114530840. [PMID: 26535322 PMCID: PMC4555594 DOI: 10.1177/2325967114530840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: There is a paucity of information regarding the effect of lesion location on surgical outcomes in the treatment of osteochondritis dissecans (OCD) of the humeral capitellum. Purpose: To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum. Study Design: Systematic review; Level of evidence, 4. Methods: All studies from the past 20 years were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum. Results: Six studies met the inclusion criteria. Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes. There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin. The failure rate for nonreconstructive operative management for lateral lesions was noted to be significant, as failure rates for peg fixation of lateral lesions was seen to be as high as 44% (4/9) in one of the studies. Conclusion: Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, are limited. The literature suggests that lesions located on the lateral capitellum—particularly those involving the lateral cartilage margin—require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location as a factor influencing surgical decision making.
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Affiliation(s)
- Joel Kolmodin
- The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul Saluan
- The Cleveland Clinic Foundation, Cleveland, Ohio, USA. ; Cleveland Clinic Sports Health Center, Garfield Heights, Ohio, USA
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Zlotolow DA, Bae DS. Osteochondral autograft transplantation in the elbow. J Hand Surg Am 2014; 39:368-72. [PMID: 24211174 DOI: 10.1016/j.jhsa.2013.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/02/2013] [Accepted: 09/02/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Dan A Zlotolow
- Department of Orthopaedics, Temple University School of Medicine, Philadelphia, PA; Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
| | - Donald S Bae
- Department of Orthopaedics, Temple University School of Medicine, Philadelphia, PA; Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
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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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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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Mihata T, Quigley R, Robicheaux G, McGarry MH, Neo M, Lee TQ. Biomechanical characteristics of osteochondral defects of the humeral capitellum. Am J Sports Med 2013; 41:1909-14. [PMID: 23749342 DOI: 10.1177/0363546513490652] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The repetitive, excessive compression forces in the radiocapitellar joint caused by elbow valgus stresses during throwing motions can result in osteochondritis dissecans (OCD) of the humeral capitellum in adolescent athletes. PURPOSE To assess the effect of elbow valgus torque on contact pressure in the radiocapitellar joint and that of central and lateral capitellar osteochondral defects on radiocapitellar joint contact pressure, elbow valgus laxity, and ulnar collateral ligament (UCL) strain. STUDY DESIGN Controlled laboratory study. METHODS In 8 matched pairs of fresh-frozen cadaveric upper limbs, lateral osteochondral defects of the humeral capitellum (5-, 10-, 15-, and 20-mm diameters) were evaluated in one side, and central defects were evaluated in the contralateral side. Radiocapitellar joint contact pressure, elbow valgus laxity, and UCL strain were all measured with and without 2 N·m of valgus torque at 30°, 60°, and 90° of elbow flexion in neutral forearm rotation. RESULTS Applying valgus torque increased contact pressure in radiocapitellar joints with intact or damaged capitula. Contact pressure in joints with 15-mm (90° of elbow flexion) and 20-mm (60° and 90° of elbow flexion) lateral capitellar defects was greater than that in joints with intact capitula. Radiocapitellar contact pressure was greater with a 20-mm lateral capitellar defect than in the same-sized central defect at 60° and 90° of elbow flexion. In both central and lateral defect groups, elbow valgus laxity increased as the size of the capitellar defect increased, and UCL strain remained unchanged regardless of the size of the capitellar defect. CONCLUSION Elbow valgus torque increases contact pressure in the radiocapitellar joint. Capitellar osteochondral defects increase elbow valgus laxity and contact pressure without increasing UCL strain. When valgus torque is applied, contact pressure in the radiocapitellar joint is greater with a lateral defect than with a central defect. CLINICAL RELEVANCE Adolescent baseball players with capitellar OCD should stop throwing, even if the UCL is intact, to prevent exacerbating the osteochondral defect. Lateral capitellar OCD is more severe than central capitellar OCD.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, Japan.
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