Arthroscopic Management of Osteochondritis Dissecans of the Capitellum: Mid-Term Results in Adolescent Athletes

Author(s): Jones KJ, Wiesel BB, Sandar WN, and Ganley TJ

Source: J Pediatr Orthop 30(1):8-13, 2010.

Summary:

Osteochondritis Dissecans (OCD) of the humeral capitellum is associated with sporting activities.  This lesion has become increasingly common in young athletes.  Valgus stresses are thought to play a role.  These have been classified according to the stability of the osteochondral fragment. 

Non-operative management appears to be most efficacious in children that have stable lesions with open capitellar growth plates.  Unstable lesions in older children respond poorly to non-operative treatment.  Surgical options are numerous and include arthroscopic drilling of the lesion, abrasion chondroplasty, and autologous osteochondral mosaicplasty.  These authors attempt to assess their mid-term results after arthroscopic management of capitellar OCD athletes in adolescents.

The patient cohort initially consisted of 25 patients.  Four children were lost to follow-up leaving twenty-one for study.  There were 14 boys and 7 girls.  All children underwent elbow arthroscopy with or with out arthrotomy.  The arthroscopic technique is described within the manuscript.  The OCD lesion was probed and all loose cartilage or fibrous tissue was debrided with a shaver.  Multiple drill holes were made in the exposed subchondral bone using k-wires of various sizes.  For patients with loose bodies at the anterior aspect of the elbow or when the inferior elbow was not adequately visualized, additional portals were created. 

Data collection consisted of patient demographics and outcome.  The single assessment numeric evaluation (SANE score) was used for patient perceived outcome measure.  This score asked the patient to rate their elbow at the time of outcome based on 100% scale.  This has been validated in previous studies. 

The most common preoperative complaint was pain followed by mechanical symptoms and decreased range of motion.  Overall, 10 elbows were treated with arthroscopic drilling of the OCD lesion.  Twelve elbows required lateral mini-arthrotomies for bone grafting or removal of large loose bodies after arthroscopy.  At mean follow-up of 48 months, the average SANE score was 87 with a range from 50-100.  There was a statistical increase in flexion extension with moderate improvement.  Overall, 86% of patients returned to participate in their sport at the pre-injury level. 

The authors present an arthroscopic approach to OCD lesions.  Their treatment outcome is defined within the manuscript.  Significant improvements were noted in range of motion with an acceptable SANE score.  However, similar to other studies concerning OCD lesions, the comparisons between patients that have OCD lesions are difficult.  The take home message is that arthroscopy can be performed but the natural history and ultimate outcome remains obscured by other confounding factors.