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Takahara M. Osteochondritis dissecans of the elbow: recent evolution of pathogenesis, imaging, and treatment modalities. JSES Int 2024; 8:588-601. [PMID: 38707580 PMCID: PMC11064639 DOI: 10.1016/j.jseint.2023.09.010] [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] [Indexed: 05/07/2024] Open
Abstract
Background The etiology and pathogenesis of osteochondritis dissecans (OCDs) lesions remain controversial. Methods This review presents the recent evolution about the healing, imaging, pathogenesis, and how to treat OCD of the capitellum in overhead athletes. Results Compressive and shear forces to the growing capitellum can cause subchondral separation, leading to OCD, composed of 3 layers: articular fragment, gap, and underlying bone. Subchondral separation can cause ossification arrest (stage IA), followed by cartilage degeneration (stage IB) or delayed ossification (stage IIA), occasionally leading to osteonecrosis (stage IIB) in the articular fragment. Articular cartilage fracture and gap reseparation make the articular fragment unstable. The mean tilting angle of capitellar OCD is 57.6 degrees in throwers. Anteroposterior radiography of the elbow at 45 degrees of flexion (APR45) can increase the diagnostic reliability, showing OCD healing stages, as follows: I) radiolucency, II) delayed ossification, and III) union. Coronal computed tomography and magnetic resonance imaging with an appropriate tilting angle can also increase the reliability. MRI is most useful to show the instability, although it occasionally underestimates. Sonography contributes to detection of early OCD in adolescent throwers on the field. OCD lesions in the central aspect of the capitellum can be more unstable and may not heal. Cast immobilization has a positive effect on healing for stable lesions. Arthroscopic removal provides early return to sports, although a large osteochondral defect is associated with a poor prognosis. Fragment fixation, osteochondral autograft transplantation, and their hybrid technique have provided better results. Discussion Further studies are needed to prevent problematic complications of capitellar OCD, such as osteoarthritis and chondrolysis.
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Affiliation(s)
- Masatoshi Takahara
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
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Ahmed AF, Alzobi OZ, Hantouly AT, Toubasi A, Farsakoury R, Alkhelaifi K, Zikria B. Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221137863. [PMID: 36479463 PMCID: PMC9720815 DOI: 10.1177/23259671221137863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications. PURPOSE To evaluate the rate of complications after elbow arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs. RESULTS A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures). CONCLUSION The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates.
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Affiliation(s)
- Abdulaziz F. Ahmed
- Division of Shoulder and Sports Medicine, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Osama Z. Alzobi
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rana Farsakoury
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Bashir Zikria
- Division of Shoulder and Sports Medicine, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Takata Y, Kitaoka K, Nakase J, Tsuchiya H. Osteochondritis dissecans of the humeral capitellum in identical twin baseball players. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:464-468. [PMID: 37588703 PMCID: PMC10426608 DOI: 10.1016/j.xrrt.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiko Kitaoka
- Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
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Chau MM, Klimstra MA, Wise KL, Ellermann JM, Tóth F, Carlson CS, Nelson BJ, Tompkins MA. Osteochondritis Dissecans: Current Understanding of Epidemiology, Etiology, Management, and Outcomes. J Bone Joint Surg Am 2021; 103:1132-1151. [PMID: 34109940 PMCID: PMC8272630 DOI: 10.2106/jbjs.20.01399] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis. ➤ While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition. ➤ Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging. ➤ Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions. ➤ Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
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Affiliation(s)
- Michael M Chau
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mikhail A Klimstra
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kelsey L Wise
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
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Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients. Arch Orthop Trauma Surg 2021; 141:1541-1549. [PMID: 33543384 PMCID: PMC8354908 DOI: 10.1007/s00402-021-03773-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/06/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting. MATERIALS AND METHODS Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24-45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected. RESULTS All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165-200), 94 (range, 70-100), and 92 (range 83-98; normative score 47; range 35-55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, - 27-100%; 52%, 4-100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted. CONCLUSION This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.
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Matsuura T, Iwame T, Iwase J, Sairyo K. Osteochondritis Dissecans of the Capitellum :Review of the Literature. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:217-221. [PMID: 33148891 DOI: 10.2152/jmi.67.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
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Affiliation(s)
- Tetsuya Matsuura
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Toshiyuki Iwame
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Jyoji Iwase
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
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Matsuura T, Iwame T, Suzue N, Takao S, Nishio S, Arisawa K, Sairyo K. Cumulative Incidence of Osteochondritis Dissecans of the Capitellum in Preadolescent Baseball Players. Arthroscopy 2019; 35:60-66. [PMID: 30611367 DOI: 10.1016/j.arthro.2018.08.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the 1-year cumulative incidence of capitellar osteochondritis dissecans (OCD) in preadolescent baseball players and identify the risk factors associated with this condition. METHODS In total, 1,275 school-aged baseball players (aged 6-11 years) without an established diagnosis of capitellar OCD were enrolled in this longitudinal, observational study. One year later, all players underwent ultrasonographic examination of the throwing elbow on the playing field. Elbows with abnormal ultrasonographic findings at this time then underwent radiographic examination. Data for the groups with and without capitellar OCD were analyzed using multivariate logistic regression models. RESULTS The 1-year cumulative incidence of capitellar OCD was 1.8% (95% confidence interval, 1.1%-2.7%). On multivariate analysis, players aged 10 to 11 years were 3.96 times more likely to have capitellar OCD (95% confidence interval, 1.10-18.97) than those aged 6 to 9 years; however, starting baseball at an earlier age, number of years played, training hours per week, player position, and history of elbow pain were not significantly associated with capitellar OCD. Only 34.8% of players with capitellar OCD reported elbow pain. CONCLUSIONS The risk of OCD of the capitellum developing within a 1-year period in preadolescent baseball players was 1.8%. Players aged 10 to 11 years had a significantly greater risk of capitellar OCD development than those aged 6 to 9 years. LEVEL OF EVIDENCE Level III, local nonrandom sample cohort.
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Affiliation(s)
- Tetsuya Matsuura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Toshiyuki Iwame
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoto Suzue
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Shoichiro Takao
- Department of Diagnostic Radiology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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