This study is a retrospective review of 106 patients with osteochondritis dissecans of the capitellum. The mean age of the patients was 15.3 years. The capitellar growth plate was open in 18 patients and closed in 88. Thirty six patients were treated nonoperatively, 55 patients underwent fragment removal alone, 12 underwent fragment fixation with a bone graft and 3 underwent reconstruction of the articular surface with use of osteochondral bone plug grafts from the lateral femoral condyle. The mean follow up was 7 years. Overall, patients with an open capitellar physis and a good range of elbow motion resulted in a good outcome without surgical intervention. However, continued elbow stress resulted in poor outcomes with respect to pain and radiographic findings. Patients with a closed capitellar physis had best outcomes following fragment fixation or reconstruction as opposed to fragment removal alone. However, capitellar defects less than 50 % after fragment removal alone resulted in outcome similar to those achieved with fragment fixation or reconstruction.
The authors recommend, based on this large retrospective review, that a stable osteochondritis dissecans lesion that is best treated with rest is a Grade I lesion with an open capitellar growth plate and normal elbow motion. Unstable osteochondritis lesions classified as either Grade II or III with a closed growth plate and restricted motion greater than 20 degrees are best treated with surgical repair or reconstruction.
Elbow, Osteochondritis, Dessicans, Capitellum, Humerus
J. Bone and Joint Surgery