Internal Fixation of Unstable In Situ Osteochondritis Dissecans Lesions of the Capitellum

Hennrikus, William; Miller, Patricia E.; Micheli, Lyle J.; Waters, Peter M.; Bae, Donald S.

doi:10.1097/bpo.0000000000000308

Cited by 55 publications

(17 citation statements)

References 47 publications

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“…We identified 6 studies 6 , 7 , 12 , 23 , 28 , 31 that evaluated return-to-sport data after fixation of capitellar OCD lesions. Several methods of fixation were used, including hydroxyapatite pins, K-wires, and Herbert screws.…”

Section: Resultsmentioning

confidence: 99%

“…Only 8 studies 7 , 8 , 16 , 23 , 25 , 26 , 30 , 31 reported a diameter for size of the OCD lesion undergoing treatment. Sizes of lesions were similar between the debridement group (13.35 mm), the fixation group (11.93 mm), and the OAT group (13.87 mm).…”

Section: Resultsmentioning

confidence: 99%

“…Loose body removal was most common after drilling or microfracture procedures occurring in 9 of 236 (3.81%) cases. Other reasons for revision surgery included conversion of fixation to OAT autograft, 7 fragment revision fixation, 7 and radial head resection for elbow stiffness. 24 There was only 1 reported postoperative infection.…”

Section: Resultsmentioning

confidence: 99%

“… 27 Operative management is typically offered for unstable lesions and those who ultimately fail nonoperative management; these lesions have been classically treated with debridement and/or marrow-stimulating procedures. 16 , 25 Proposed alternatives to this mode of treatment have been fragment fixation 6 , 7 , 23 , 31 or resection and replacement with osteoarticular autograft transfer (OAT). 15 , 30 , 34 …”

mentioning

confidence: 99%

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Return to Sport After Operative Management of Osteochondritis Dissecans of the Capitellum

Westermann

Hancock

Buckwalter

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Capitellar osteochondritis dissecans (OCD) is commonly managed surgically in symptomatic adolesent throwers and gymnasts. Little is known about the impact that surgical technique has on return to sport.Purpose:To evaluate the clinical outcomes and return-to-sport rates after operative management of OCD lesions in adolescent athletes.Study Design:Systematic review; Level of evidence, 4.Methods:The PubMed, CINAHL, EMBASE, SPORTDiscus (EBSCO), and Cochrane Central Register of Controlled Trials databases were queried for studies evaluating outcomes and return to sport after surgical management of OCD of the capitellum. Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting patient outcomes with return-to-sport data and minimum 6-month follow-up were included in the review.Results:After review, 24 studies reporting outcomes in 492 patients (mean age ± SD, 14.3 ± 0.9 years) were analyzed. The overall return-to-sport rate was 86% at a mean 5.6 months. Return to the highest preoperative level of sport was most common after osteochondral autograft procedures (94%) compared with debridement and marrow stimulation procedures (71%) or OCD fixation surgery (64%). Elbow range of motion improved by 15.9° after surgery. The Timmerman-Andrews subjective and objective scores significantly improved after surgery. Complications were low (<5%), with 2 cases of donor site morbidity after osteoarticular autograft transfer (OAT) autograft harvest. The most common indications for reoperation were repeat debridement/loose body removal.Conclusion:A high rate of return to sport was observed after operative management of capitellar OCD. Patients were more likely to return to their highest level of preoperative sport after OAT autograft compared with debridement or fixation. Significant improvements in elbow range of motion and patient outcomes are seen with low complication rates after OCD surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Return to Sport After Operative Management of Osteochondritis Dissecans of the Capitellum

Westermann

Hancock

Buckwalter

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…When using the outside in technique, fluoroscopy Discontinuity and non-circularity of the chondral surface signal of the capitellum and no high signal interface apparent between the lesion and the floor Itsubo et al [25] is used to identify the lesion and an ACL guide can be useful for targeting the lesion. When the OCD lesion is intact but unstable, internal fixation has been found to be successful for larger osteochondral fragments [45]. After identification of the lesion arthroscopically, the fragment is gently elevated and the bed is prepared by removing sclerotic bone and fibrous tissue which can be enhanced with cancellous bone graft.…”

Section: Arthroscopic Managementmentioning

confidence: 99%

Elbow Injuries in the Adolescent Thrower

Griffith

Kercher

Willimon

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of Review With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Recent Findings Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. Summary With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes.

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Elbow Joint

Spittler¹,

Seidl²

2020

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Internal Fixation of Unstable In Situ Osteochondritis Dissecans Lesions of the Capitellum

Abstract: Level IV.

Cited by 55 publications

References 47 publications

Return to Sport After Operative Management of Osteochondritis Dissecans of the Capitellum

Return to Sport After Operative Management of Osteochondritis Dissecans of the Capitellum

Elbow Injuries in the Adolescent Thrower

Elbow Joint

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