Short-term clinical results of arthroscopic osteochondral fixation for elbow osteochondritis dissecans in teenaged baseball players

Background: Osteochondritis dissecans (OCD) of the elbow has almost exclusively been described in the humeral capitellum, with only a small number of reports describing secondary osteochondral changes in the radial head. Hypothesis: The authors hypothesized that concomitant radial head lesions (RHLs) would be seen with capitellar OCD and that patients with RHLs would present with more advanced capitellar OCD lesions and would respond better to procedures restoring articular congruity. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 86 elbows from 82 patients (39 female patients; mean ± SD age, 13.8 ± 2.2 years; age range, 9.8-23.6 years) were treated for capitellar OCD and enrolled in a prospective registry. Clinical and radiographic data were compared between those with and without RHLs, with a median follow-up of 10.8 months (interquartile range, 6.2-17.1 months). Magnetic resonance imaging was used to characterize and measure RHLs and OCD lesions. Postoperative clinical results were compared between patients who underwent drilling and those who had osteochondral autograft transplantation surgery (OATS). Results: RHLs were present in 26 (30%) elbows—17 in the dominant arm. Edema was seen in 22 elbows; 17 had involvement of the anterior third of the radial epiphysis. Cysts were present in 4 elbows: 2 in the anterior third and 2 in the middle third. Blunting of the normal concave contour of the radial epiphysis was present in 10 elbows in the anterior third. Demographic and presenting clinical features were similar between those with and without RHLs. RHLs were more commonly seen in Nelson grade 4 OCD lesions ( P = .04) as compared with elbows without RHLs. Elbows with RHLs that underwent OATS (n = 9) trended toward greater improvement in forearm range of motion ( P = .058) and fewer persistent mechanical symptoms ( P = .06) postoperatively as compared with elbows having RHLs that underwent drilling. There were no postoperative differences in elbows without RHLs that underwent OATS versus drilling. Conclusion: RHLs were seen in one-third of elbows with capitellar OCD. Lesions predominantly occurred in the anterior RH in patients with more advanced capitellar lesions. Short-term clinical follow-up suggested greater improvement in range of motion and resolution of mechanical symptoms for patients with RHLs who were treated with OATS than with drilling.

Download Full-text

Comparison of the short-term clinical results of silicone and acrylic intraocular lens in patients with diabetes mellitus

Korean Journal of Ophthalmology ◽

10.3341/kjo.2001.15.1.15 ◽

2001 ◽

Vol 15 (1) ◽

pp. 15 ◽

Cited By ~ 2

Author(s):

H K Choung ◽

J H Lee

Keyword(s):

Diabetes Mellitus ◽

Intraocular Lens ◽

Clinical Results ◽

Short Term ◽

Patients With Diabetes

Download Full-text

Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players

JBJS Essential Surgical Techniques ◽

10.2106/jbjs.st.17.00058 ◽

2018 ◽

Vol 8 (1) ◽

pp. e8 ◽

Cited By ~ 2

Author(s):

Hiroyuki Oshiba ◽

Toshiro Itsubo ◽

Masatoshi Komatsu ◽

Shigeharu Uchiyama ◽

Hiroyuki Kato

Keyword(s):

Osteochondritis Dissecans ◽

Baseball Players

Download Full-text

Age-Specific Prevalence and Clinical Characteristics of Humeral Medial Epicondyle Apophysitis and Osteochondritis Dissecans: Ultrasonographic Assessment of 4249 Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117707703 ◽

2017 ◽

Vol 5 (5) ◽

pp. 232596711770770 ◽

Cited By ~ 20

Author(s):

Kenichi Otoshi ◽

Shinichi Kikuchi ◽

Kinshi Kato ◽

Ryohei Sato ◽

Takahiro Igari ◽

...

Keyword(s):

Osteochondritis Dissecans ◽

Morphological Changes ◽

Medial Epicondyle ◽

Baseball Players ◽

Elbow Pain ◽

Elbow Injuries ◽

Bony Healing ◽

History Of ◽

Study Participants ◽

Ultrasonographic Assessment

Background: Traction apophysitis of medial epicondyle (MEC) lesions and osteochondritis dissecans (OCD) of the capitellum are common elbow injuries in adolescent baseball players. However, the age-specific prevalence of these pathologies and their influence on elbow pain remain unknown. Purpose: To investigate the age-specific prevalence of each MEC lesion and capitellar OCD and to identify the incidence of elbow pain in each condition. Study Design: Descriptive epidemiology study. Methods: Study participants consisted of 4249 baseball players aged 6 to 17 years. A questionnaire was used to assess history of elbow pain, and morphological changes of the elbow joint were assessed using ultrasonography. Results: Regarding MEC lesions, fragmented (FG) and irregular (IR) lesions both reached their greatest respective prevalence at 11 to 12 years of age. After 14 years of age, IR decreased sharply, whereas FG was maintained at approximately 10%. Hypertrophic (HT) lesions increased sharply, reaching over 50% at 16 years of age, while there was a decrease in IR and FG lesions in the same age group. The prevalence of capitellar OCD remained the same (approximately 2%) throughout all ages except for in players aged 7 to 8 years (>7%). Players with MEC lesions had significantly greater prevalence of a history of elbow pain compared with those without (68.0% vs 39.1%) and were at a significantly greater risk for FG lesions (odds ratio [OR], 4.04; 95% CI, 3.16-5.22) compared with IR (OR, 3.22; 95% CI, 2.44-4.27) and HT lesions (OR, 2.03; 95% CI, 1.75-2.36). Players with capitellar OCD also had a significantly greater risk of a history of elbow pain (OR, 2.34; 95% CI, 1.40-4.11). Conclusion: Controlling the amount of practice and its intensity according to the condition of each player in the preadolescent and adolescent periods may be important in accelerating bony healing and decreasing preventable elbow pain in adulthood.

Download Full-text