Osteochondritis Dissecans of the Humeral Trochlea: Characterization of a Rare Disorder Based on 28 Cases

Abstract

Background: Osteochondritis dissecans (OCD) of the humeral trochlea is very rare. It may cause pain, mechanical symptoms, and loss of elbow motion, typically in the adolescent athlete. However, little published information is available regarding this condition. Purpose: To describe the clinical presentation, radiographic features, and prognosis of trochlear OCD. Study Design: Case series; Level of evidence, 4. Methods: Over a 10-year period, 28 patients presented to a tertiary pediatric hospital with trochlear OCD. Medical records and imaging were analyzed to characterize presentation, lesions appearances, and outcomes. Results: Mean ± SD age at presentation was 13.4 ± 1.6 years, and 13 of the 28 patients were male. The most common presenting symptom was pain (93%), followed by crepitus (54%). Evidence of trochlear OCD could be seen on initial radiographs in 94% of cases but was commonly missed. Coexisting capitellar OCD lesions were the most common associated abnormalities seen on magnetic resonance imaging (21%). Investigators noted 2 predominant patterns: “typical” trochlear OCD lesions (89%) were located on the lateral crista of the trochlea, 3.1 ± 4.4 mm lateral to the apex of the trochlear groove. This location corresponded to the medial tip of the capitellar epiphyseal ossification center and was not actually on the trochlear ossification center. “Atypical” trochlear OCD lesions (11%) were located more posteromedially. Trochlear OCD lesions in 4 elbows were managed surgically, while the remainder were managed nonoperatively. At mean ± SD follow-up of 13 ± 8 months, 12 patients (43%) were asymptomatic. A further 5 patients had ongoing crepitus but no pain (18%), and 4 patients (14%) underwent surgical treatment for their trochlear OCD (osteochondral fixation, n = 1; drilling/curettage, n = 3); 3 of the 4 patients experienced some improvement in pain. Conclusion: Although rare, trochlear OCD can cause considerable elbow problems. Clinicians should be aware of this differential diagnosis. Plain radiographs should be carefully scrutinized for subtle signs of trochlear OCD, particularly in the repetitive or overhead athlete with elbow pain. Although most patients’ symptoms will improve with activity modification, some may require surgery.

Arthroscopic Ulnohumeral Joint Debridement and Transolecranon Microfracture for Osteochondritis Dissecans of the Humeral Trochlea

“…Inadequate debridement of lesiondavoid by lifting delaminated cartilage from inside out until adherent cartilage is met e4 management. 1,2 The advantage of our technique is that it facilitates access to the ulnohumeral joint with minimal morbidity and allows for both debridement and microfracture through the same approach.…”

“…In the sagittal plane, trochlea OCDs are located at a mean of 190 from the anterior humeral line as quantified by Johnson method (Fig 3). 2,4 As such, they were previously thought inaccessible without olecranon osteotomy.…”

“…They are commonly misdiagnosed, and few are diagnosed before presenting to a specialized upper-extremity service. 1 , 2 Fortunately, the majority of trochlea OCDs present with characteristic radiologic features that distinguish them from other pathologies. 2 A “typical” trochlea OCD presents at a mean age of 13 years with pain (93%), crepitus (54%), mechanical symptoms (32%), and loss of motion (32%).…”

“… 1 , 2 Fortunately, the majority of trochlea OCDs present with characteristic radiologic features that distinguish them from other pathologies. 2 A “typical” trochlea OCD presents at a mean age of 13 years with pain (93%), crepitus (54%), mechanical symptoms (32%), and loss of motion (32%). 2 The characteristic radiographic finding is a “pseudo-intercondylar notch sign” or lucent lesion just lateral to the apex of the trochlear groove ( Fig 1 ).…”

“… 2 A “typical” trochlea OCD presents at a mean age of 13 years with pain (93%), crepitus (54%), mechanical symptoms (32%), and loss of motion (32%). 2 The characteristic radiographic finding is a “pseudo-intercondylar notch sign” or lucent lesion just lateral to the apex of the trochlear groove ( Fig 1 ). 3 This corresponds with a hyperintense lesion on fluid-weighted magnetic resonance imaging ( Fig 2 ).…”