Radiographic comparison of adolescent athletes with elbow osteochondritis dissecans to ulnar collateral ligament injuries and controls

Lau, Brian C.; Pandya, Nirav K.

doi:10.1016/j.jse.2016.09.037

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…First, other potential risk factors for elbow injuries in young baseball players were not examined, including the number of games per year, thoracic alignment, side-to-side differences in elbow extension, carrying angle of the elbow, and shoulder muscle strength. 10,14,21,35 Moreover, we did not examine aspects of throwing mechanics, such as elbow valgus torque, ball velocity, and throwing form. Second, the training time and number of throws were surveyed using a questionnaire: to ensure accurate responses, each questionnaire was completed with help of parents and coaches; however, these were still self-reports, which may not have provided accurate and complete data.…”

Section: Discussionmentioning

confidence: 99%

Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players

Saito,

Okada,

Shibata

et al. 2023

Am J Sports Med

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Background: Young baseball players with medial elbow injuries are known to have high forearm flexor-pronator muscle elasticity; however, the causal relationship between forearm muscle elasticity and the occurrence of medial elbow injuries remains unclear. Purpose/Hypothesis: The purpose of this study was to determine whether the forearm flexor-pronator muscle elasticity is a risk factor for medial elbow injury in young baseball players. It was hypothesized that high flexor carpi ulnaris (FCU) elasticity would be a risk factor for medial elbow injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Young baseball players (aged 9-12 years) with no history of elbow injuries underwent examination during which the strain ratios (SRs) of the pronator teres, flexor digitorum superficialis, and FCU muscles were measured using ultrasound strain elastography as an index of elasticity. Additionally, the participants completed a questionnaire assessing age, height, weight, months of experience as a baseball player, position in baseball, number of training days per week, number of throws per day, and elbow pain during throwing; then the range of motion of the shoulder and hip internal/external rotation were measured. One year after the baseline measurements, the occurrence of new medial elbow injuries was evaluated. Multivariate logistic regression analysis was subsequently conducted to determine risk factors for medial elbow injuries. Cutoff points for significant SR values obtained from the multivariate logistic regression analysis were calculated using the receiver operating characteristic curve. Results: Of the 314 players, 76 (24.2%) were diagnosed with medial elbow injury. Multivariate logistic regression analysis showed that a 0.1 increase in the SR of the FCU muscle (odds ratio [OR], 1.211; 95% CI, 1.116-1.314) and number of throws per day (OR, 1.012; 95% CI, 1.001-1.022) were significantly associated with medial elbow injuries. Receiver operating characteristic curve analyses revealed that the optimal cutoff for the SR of the FCU muscle was 0.920 (area under the curve, 0.694; sensitivity, 75.0%; specificity, 56.7%). Conclusion: Increased FCU elasticity is a risk factor for medial elbow injury. Evaluation of the FCU elasticity may be useful in identifying young baseball players at high risk of medial elbow injuries and may facilitate prevention of medial elbow injury. As shown by the results of multivariate logistic regression analysis, FCU elasticity itself may be useful in identifying young baseball players at high risk of elbow injuries. However, we believe that other factors, such as the number of pitches per day, need to be considered to improve its accuracy.

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Section: Discussionmentioning

confidence: 99%

Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players

Saito,

Okada,

Shibata

et al. 2023

Am J Sports Med

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“…2 and 3, Table II) 16,17 . The anteroposterior carrying angle and the anteroposterior radial neck-shaft angle were recorded 18 . The anteroposterior capitellar width was evaluated using the method of Takahara et al 19 .…”

Section: Radiographic Datamentioning

confidence: 99%

Elbow Overuse Injuries in Pediatric Female Gymnastic Athletes

Wilson

Wyatt

Searls

et al. 2021

Journal of Bone and Joint Surgery

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Background: Radial head stress fractures (RHSFs) and capitellar osteochondritis dissecans (COCD) are rare but may be seen in gymnasts. The purpose of this study was to compare the clinical and radiographic characteristics and the outcomes of RHSF and COCD in pediatric and adolescent gymnastic athletes.Methods: Classical gymnasts and competitive tumblers £18 years of age presenting with RHSF or COCD over a 5-year period were reviewed. Radiographic characteristics, clinical characteristics, and patient-reported outcomes were compared.Results: Fifty-eight elbows (39 with COCD and 19 with RHSF) were studied; the mean patient age was 11.6 years.Gymnastic athletes with RHSF competed at a higher level; of the athletes who competed at level ‡7, the rate was 95% of elbows in the RHSF group and 67% of elbows in the COCD group. The RHSF group presented more acutely with more valgus stress pain than those with COCD (p < 0.01) and demonstrated increased mean valgus angulation (and standard deviation) of the radial neck-shaft angle (13°± 3.8°for the RHSF group and 9.3°± 2.8°for the COCD group; p < 0.01) and decreased mean proximal radial epiphyseal height (3.7 ± 0.6 mm for the RHSF group and 4.2 ± 1.5 mm for the COCD group; p < 0.01). At a minimum of 2 years (range, 2.0 to 6.3 years), the RHSF group reported fewer symptoms; the QuickDASH (abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score was 1.75 ± 3.84 points for the RHSF group and 7.45 ± 7.54 points for the COCD group (p < 0.01). Those at a high level ( ‡7) were more likely to return to gymnastics independent of pathology, with the RHSF group reporting higher final activity levels with the mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) score at 26.0 ± 7.5 points compared with the COCD group at 23.6 ± 5.7 points (p < 0.05). Of the 9 patients with bilateral COCD, only 3 (33%) returned to gymnastics.Conclusions: RHSF with features similar to the more familiar COCD lesion may present in gymnastic athletes. Those with RHSF may present more acutely with a high competitive level and may have a better prognosis for return to competitive gymnastics than those with COCD.

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“…Although the utilization of upper extremity osteotomy procedures to off-load cartilaginous pathology in the elbow is not as commonly performed as in the knee (this can be largely be postulated to be due to the weight-bearing nature of the knee as well as both the complex neurovascular structures and three-dimensional anatomy of the elbow), this must be considered as well in the setting of failed surgery. Lau et al found that compared with control patients, adolescent patients with capitellar OCD lesions had more varus carrying angles and more valgus at the distal humeral articular surface [34]. Various joint re-alignment procedures have been described including closed-wedge osteotomies of the distal humerus [35] as well as radial shortening [36] to off-load stress on the injured area.…”

Section: Assessment Of Alignmentmentioning

confidence: 99%

Failure of Surgery for Osteochondral Injuries of the Elbow in the Pediatric and Adolescent Population

Chen¹,

Pandya

2020

Curr Rev Musculoskelet Med

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Purpose of Review With an increase in single-sport specialization, elbow injuries have become increasingly common in the pediatric and adolescent population. Osteochondritis dissecans (OCD) of the capitellum frequently requires intervention yet can be difficult to treat given high patient activity demands. The purpose of this paper is to review treatment options, understand failure rates, and provide strategies for successful revision surgery.Recent Findings Patients at high risk for the development of this condition are involved in high-demand upper extremity activity such as baseball or gymnastics. Treatment options include non-operative management, drilling, fixation, loose body removal/ microfracture, osteochondral autograft, and osteochondral allograft. Cartilage preservation procedures (i.e., osteochondral autograft) have a significant advantage in terms of clinical and radiographic healing compared with fixation or microfracture. Summary Capitellar OCD lesions afflict a large number of adolescent athletes today and will likely continue increasing in number from sports-related injuries. It is critical to recognize and treat these lesions in a timely and appropriate fashion to optimize clinical outcomes. When faced with failure of healing, surgeons must critically analyze reasons for failure including post-operative compliance, return to high-demand sporting activity, fixation of non-viable fragments, utilization of microfracture, alignment, and concomitant pathology.

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Radiographic comparison of adolescent athletes with elbow osteochondritis dissecans to ulnar collateral ligament injuries and controls

Cited by 6 publications

References 29 publications

Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players

Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players

Elbow Overuse Injuries in Pediatric Female Gymnastic Athletes

Failure of Surgery for Osteochondral Injuries of the Elbow in the Pediatric and Adolescent Population

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