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

Abstract

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.

Donor-site morbidity after osteochondral autologous transplantation for osteochondritis dissecans of the capitellum: a systematic review and meta-analysis

“…One may argue whether it is valid to combine study data because of between-study variance; however, we attempted to alleviate statistical heterogeneity with the use of a random effects model. This model has been used previously in systematic reviews who pooled data from case series studies [19, 34]. …”

“…Proportions of donor-site morbidity were calculated for each study using the Freeman-Tukey double arcsine transformation. Subsequently, a random effects model, to account for heterogeneity across studies, was used to calculate weighted group proportions for each harvest technique, and to compare proportions between the two techniques [19, 34]. A p value <0.05 was considered significant.…”

Histologic Analysis of 2 Alternative Donor Sites of the Ipsilateral Elbow in the Treatment of Capitellar Osteochondritis Dissecans

“…5,12 Promising outcomes in terms of pain relief, elbow function, and return to sporting activities have been reported after capitellar OATS. [1][2][3]13 However, donorsite morbidity remains a problem and the subject of ongoing debate. 14,15 A systematic review performed by our research group demonstrated considerable donorsite morbidity: 7.8% after harvesting from the knee (mainly knee pain during activities) and 1.6% after harvesting from the rib (1 pneumothorax that required insertion of a chest tube).…”

Elbow Injuries in the Adolescent Thrower

“…Similarly, Bexkens et al demonstrated a much lower return-to-play rate of 62% in those with advanced stage [58]. Westerman et al performed a systematic review and meta-analysis on return to sport after operative management of OCD lesions [59]. They evaluated 24 studies reporting outcomes in 492 patients.…”