Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players

Oshiba, Hiroyuki; Itsubo, Toshiro; Komatsu, Masatoshi; Uchiyama, Shigeharu; Kato, Hiroyuki

doi:10.2106/jbjs.st.17.00058

Cited by 8 publications

(10 citation statements)

References 14 publications

(7 reference statements)

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“…Indications for bone peg grafting have only been reported in cases up to ICRS grade I or II. 11,15 Given that the results of this study were obtained for ICRS grade III or IV, we believe that the osteotomy effect is significant. Regarding the clinical outcomes of closed-wedge osteotomy, Kiyoshige et al 7 reported on 7 patients with an early-stage OCD lesion.…”

Section: Discussionmentioning

confidence: 93%

Closed-Wedge Osteotomy of the Distal Humerus for Treating Osteochondritis Dissecans of the Capitellum in Young Patients

Ueki¹,

Moriya²,

Yoshizu³

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Even in patients with an open capitellar physis, nonsurgical treatment for advanced-stage osteochondritis dissecans (OCD) of the capitellum often yields poor outcomes. However, surgical methods for such patients are controversial. At our institution, we have consistently performed closed-wedge osteotomy of the distal humerus to treat advanced-stage OCD of the capitellum, regardless of the OCD grade or condition of the capitellar physis.Purpose:To clarify the clinical and radiological results and determine the influence of the capitellar physis on closed-wedge osteotomy for advanced-stage OCD of the capitellum in young patients.Study Design:Case series; Level of evidence, 4.Methods:A total of 32 patients with OCD of the humeral capitellum were treated surgically with closed-wedge osteotomy. Of these, 17 patients with more than 2-year follow-up were available for an evaluation. The mean patient age was 11.8 years (range, 11-12 years), and the mean follow-up period was 70.1 months (range, 25-184 months). The clinical assessment included range of motion, elbow pain, and the Japanese Orthopaedic Association (JOA) and Timmerman-Andrews scores. The radiological assessment at the final examination included cross-bridging of the physis, size and fishtail deformity of the distal part of the humerus, size of the radial head, healing of the OCD lesion, and osteoarthritis.Results:The mean range of motion and JOA and Timmerman-Andrews scores improved significantly after surgery; 13 patients were completely pain free. In 11 patients with an open capitellar physis, metaphyseal-epiphyseal, cross-bridging was observed in 1 patient. A fishtail deformity of the distal part of the humerus was not observed. Healing of the OCD lesion was defined as excellent in 9 patients, good in 3, fair in 3, and poor in 2. In 3 of the 5 patients in whom healing was described as fair or poor, there was a lesion of the lateral widespread type with osteoarthritis before surgery. Moderate osteoarthritic changes were evident in 2 patients.Conclusion:Closed-wedge osteotomy for the treatment of advanced-stage OCD of the capitellum in young patients can provide satisfactory clinical and radiological results. However, fair and poor outcomes were found in lateral widespread–type cases with osteoarthritis before surgery. We believe that patients in whom osteoarthritic changes have not yet appeared are eligible for closed-wedge osteotomy.

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Section: Discussionmentioning

confidence: 93%

Closed-Wedge Osteotomy of the Distal Humerus for Treating Osteochondritis Dissecans of the Capitellum in Young Patients

Ueki¹,

Moriya²,

Yoshizu³

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…As a consequence of the findings described above, many authors tend to replace the subchondral, malvascularized bone in advanced OCD stages (e.g. grades III to IV) using osteochondral bone grafts [ 16 , 17 , 36 , 37 ]. This can provide additional healthy hyaline cartilage as new joint surface tissue, either transplated as a single bone plug or mosaicplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Oshiba et al, who used multiple bone plugs for mainly early lesions (ICRS grade I and II; Minami stage I and II) reported complete radiological healing in 8 of 11 cases; however, healing needed up to 24 months to become evident in MRI [ 16 ]. Another study has, however, shown that large-size defects, which span from the lateral to the central articular portion, may not heal as well as central lesions after OAG transplantation [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, several partial improvements, such as a changes of the subchondral congruency from “flattened” to “convex” (in 2 cases), reduction of sclerosis (in 2 cases) and normalization of transparency and fragementation (in 1 case each) were observed. In regard to MRI findings, previous studies have shown that signs of the disease may still be visible up to 24 months after surgery [ 36 ]. Our postoperative MRIs showed lack of subchondral and capitellar bone marrow edema with, however, expected irregularities next to the healthy hyaline cartilage as a sign of fibrous regenerate tissue in the scaffold area (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

Farr

Pallamar

Eder

et al. 2021

Arch Orthop Trauma Surg

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Introduction Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting. Materials and methods Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24–45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected. Results All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165–200), 94 (range, 70–100), and 92 (range 83–98; normative score 47; range 35–55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, − 27–100%; 52%, 4–100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted. Conclusion This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.

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“…Almost all reports are retrospective level-4 studies. 4,15,20,29,37,41,43,[60][61][62][63][64][65][66][67][68] Furthermore, there are no exact definitions of the different surgical procedures such as debridement and/or chondroplasty versus microfracturing or mosaicplasty versus OAT. 4,15,20,29,37,41,43,[60][61][62][63][64][65][66][67][68] Even when authors had sampled a reasonable number of patients treated differently a comparison has not been done.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Osteochondritis Dissecans of Smaller Joints: The Elbow

Bruns¹,

Werner

Habermann

2019

CARTILAGE

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This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.

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Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players

Cited by 8 publications

References 14 publications

Closed-Wedge Osteotomy of the Distal Humerus for Treating Osteochondritis Dissecans of the Capitellum in Young Patients

Closed-Wedge Osteotomy of the Distal Humerus for Treating Osteochondritis Dissecans of the Capitellum in Young Patients

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

Osteochondritis Dissecans of Smaller Joints: The Elbow

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