Radiographic evaluation of osteochondritis dissecans of the humeral capitellum: A systematic review

Introduction. The osteochondritis dissecans (OCD) is a pathologic condition of osteochondral tissue predominantly in the femoral condyles, which is met most often in adolescents and which can lead to the formation of early arthrosis in the knee joint in the remote time. By modern concepts, stable OCD foci are the foci with intact articular cartilage without the risk of migration into the joint cavity. To date, there are very few studies in the world literature on the treatment of early stages of osteochondrosis dissecans.Material and methods. Two independent researchers have carried out a systematic review of literature sources (2000-2020 ) using Pubmed, Medline and GoogleScholar. 9 publications were selected for data analysis out of 5184 publications after the qualitative assessment by the Yang scale and the obtained consensus in disputable situations.Results. Statistical analysis of the obtained data with the Statistica program revealed that the average rate of OCD foci healing was seen in 86.7% (from 70.6 to 100%). The most effective outcomes were in the group of antegrade drilling (95.3% of healed foci), then in the group with biodegradable implants fixation (88.5%), then the group of antegrade drilling with the introduction of bone marrow aspirate concentrate (BMAC) - 76.9%, and then the retrograde drilling - 76.8%.Conclusion. The analysis performed have shown a significant heterogeneity in data reporting, different methods for diagnosing osteochondritis dissecans, different approaches to healing assessment as well as a small number of children in samples what determined the lack of statistical significance between different options of surgical treatment (p = 0.27). Carefully planned trials with a proper design, standardized techniques for healing assessment and time of their application as well as the assessment of comparison groups and of all other necessary factors affecting lesion healing are needed.

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A Comparison of Surgical and Medical Treatment of Fragmented Coronoid Process and Osteochondritis Dissecans of the Canine Elbow

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632452 ◽

1995 ◽

Vol 08 (04) ◽

pp. 177-183 ◽

Cited By ~ 38

Author(s):

C. W. Miller ◽

C. L. Taves ◽

G. R. Bouck

Keyword(s):

Medical Treatment ◽

Osteochondritis Dissecans ◽

Weight Bearing ◽

Force Plate ◽

Normal Weight ◽

Coronoid Process ◽

Radiographic Evaluation ◽

Prospective Clinical Study ◽

Plate Analysis

SummaryA randomized prospective clinical study was performed to compare the effect of surgery for fragmented coronoid process (FCP) and osteochondritis dissecans (OCD) of the canine elbow, with medical treatment using pentosan polysulphate (PPS). Nineteen dogs with FCP and/or OCD of the elbow were randomly assigned to either the surgical or medical group. Lameness examination, radiographic evaluation and force plate analysis were performed at the time of admission, and were repeated at two, four, six and nine months after treatment. In dogs with asymmetrical lameness, in both the medical and surgical groups, the peak vertical forces and mean vertical forces for the more affected limbs were significantly lower than the control means at time zero. In both the medical and surgical group, the peak and mean vertical forces improved during the course of the study. Weightbearing in medically treated dogs approached that in controls at a faster rate than in those treated surgically. After nine months of follow-up, differences could not be detected between the dogs treated surgically, and those treated with PPS.Surgical and medical treatment for fragmented coronoid process and osteochondritis dissecans of the canine elbow were compared. Medical treatment resulted in a more rapid return to normal weight-bearing than did surgical treatment. After nine months of follow-up, differences were not detected between the medically and surgically treated dogs.

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Predictive Role of Symptom Duration Before the Initial Clinical Presentation of Adolescents With Capitellar Osteochondritis Dissecans on Preoperative and Postoperative Measures: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118825059 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711882505 ◽

Cited By ~ 2

Author(s):

Christopher Cheng ◽

Matthew D. Milewski ◽

Jeffrey J. Nepple ◽

Hannah S. Reuman ◽

Carl W. Nissen

Keyword(s):

Systematic Review ◽

Osteochondritis Dissecans ◽

Surgical Procedure ◽

Clinical Presentation ◽

Return To Sport ◽

Chief Complaint ◽

Postoperative Outcomes ◽

Symptom Duration ◽

Cochrane Central Register ◽

Young Athletes

Background: Osteochondritis dissecans (OCD) of the capitellum is an increasingly recognized disease affecting young athletes. Because lesion progression is common, early identification is potentially beneficial for an athlete’s treatment and recovery. However, there is currently no analysis available that evaluates the impact of symptom duration on preoperative and postoperative outcomes. Purpose/Hypothesis: The purpose of this study was to perform a systematic review of surgically treated OCD lesions to examine the effect of symptom duration before the initial presentation on preoperative and postoperative outcomes. We hypothesized that a longer symptom duration would correlate with more severe preoperative signs and symptoms and poorer postoperative outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: Ovid MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects were queried for studies evaluating symptom duration before the clinical presentation of capitellar OCD and surgical outcomes. A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: A total of 23 studies reporting outcomes in 258 patients (mean patient age, 14.4 ± 1.5 years) were analyzed. Locking as a chief complaint predominated in a greater proportion of patients who presented with a longer history of OCD symptoms ( P = .007). A longer symptom duration also correlated with a longer time to return to sport ( P = .008) and older age ( P < .001). Range of motion limitations as both a chief complaint and a physical examination finding correlated with a longer symptom duration ( P = .014 and .001, respectively). Symptom duration did not show a relationship with most postoperative outcomes, including the return-to-sport rate ( P = .172), which ranged from 70.7% to 91.1% depending on the surgical procedure performed. No significant difference was observed between symptom duration and the surgical procedure performed ( P = .376). Conclusion: Advanced OCD lesions were observed in patients with a longer symptom duration. However, treatment specifics rather than symptom duration correlated best with return to sport for patients with advanced OCD lesions requiring surgery. The earlier detection of capitellar OCD may be valuable in reducing the severity of lesions, the time to return to sport, and potential need for surgery in young athletes.

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