Magnetic Resonance Imaging After Arthroscopic Microfracture of Capitellar Osteochondritis Dissecans

Abstract

Arthroscopic OCD fragment excision and capitellar microfracture demonstrates good to excellent functional results in short-term follow-up. Follow-up MRI suggests potential for a reparative fibrocartilaginous articular surface. Longer term follow-up is necessary to determine durability of the technique.

Tratamiento artroscópico de la osteocondritis disecante del codo

“…En el resto de los pacientes el resultado clínico y funcional fue satisfactorio. Esta técnica presenta mejores resultados en pacientes con la fisis abierta, probablemente debido a que la osificación endocondral de la placa de crecimiento del capitellum puede jugar un papel en el proceso de curación de las lesiones osteocondrales (23,24) .…”

“…Las microfracturas promueven la formación de fibrocartílago, que se sabe que es menos duradero que el cartílago hialino y esto puede condicionar malos resultados en pacientes con alta exigencia de carga de la articulación (23) . Recientemente ha sido descrita la opción quirúrgica de asociar las perforaciones con un suplemento de cartílago alogénico micronizado para promover la formación de cartílago hialino, pero aún no existe evidencia de que este método sea superior a las perforaciones simples (25) .…”

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

“…Most believe that repetitive microtrauma across the radiocapitellar joint combined with limited vascularity to the developing chondroepiphysis leads to subchondral bone and articular cartilage failure. Surgical options include simple debridement and loose body removal 2,3,11,12 ; abrasion arthroplasty [13][14][15][16] ; drilling, microfracture, or other marrow stimulation techniques 12,17,34 ; bone grafting 18,20 ; OATS, 3,28-32 or combinations thereof. Classification schemes focus on the integrity of the subchondral bone and overlying articular cartilage, dividing OCD into stable and unstable lesions.…”

Osteochondritis dissecans of the elbow

“…Two patients did not return to prior levels of athletics. The average time to return to sport was 5.1 months with all patients showing improved functional outcome scores [39]. In Lewine et al, average OCD lesions were 9.8 mm in the coronal plane, 9.1 mm in the sagittal plane, and 3 mm in depth.…”

“…These patients responded well and healed with non-operative treatment whereas patients with unstable lesions (a closed capitellar physis, fragmentation on X-rays, and a range of motion lacking more than 20°) had better outcomes with operative intervention [37]. While Takahara and colleagues did not use MRI characteristics in their assessment of the stability of the OCD lesion, other authors have strongly advocated the use of the MRI characteristics described in the above sections to add to the stability assessment [6,7,13,19,21,22,29,32,33,38,39]. Thus, generally, the stability of a lesion is determined by the status of the capitellar physis, the size and location of the lesion, and the nature of the lesion based on imaging [19].…”