Cartilage Degeneration at Symptomatic Persistent Olecranon Physis in Adolescent Baseball Players

Abstract

Background. Elbow overuse injuries are common in adolescent baseball players, but symptomatic persistent olecranon physis is rare, and its pathogenesis remains unclear. Purpose. To examine the histopathological and imaging findings of advanced persistent olecranon physis. Methods. The olecranon physes of 2 baseball pitchers, aged 14 and 15 years, were examined by preoperative magnetic resonance imaging (MRI), and surgical specimens were examined histologically. Results. T2-weighted MRI revealed alterations in the intrachondral signal intensity possibly related to collagen degeneration and increased free water content. Histological findings of specimens stained with hematoxylin-eosin showed complete disorganization of the cartilage structure, hypocellularity, chondrocyte cluster formation, and moderately reduced staining. All these findings are hallmarks of osteoarthritis and are suggestive of cartilage degeneration. Conclusion. Growth plate degeneration was evident in advanced cases of symptomatic persistent olecranon physis. These findings contribute to understanding the pathogenesis of this disease.

Fracture of a persistent olecranon physis in an adult

“…In addition, we showed that degeneration of cartilage matrix was present. Enishi et al reported the presence of cartilage degeneration in the persistent olecranon physis of an adolescent baseball player [8] , which is consistent with our finding. The olecranon fracture traversed the middle of the physis remnant.…”

“…It has been reported that conservative therapy failed to heal a fracture of the persistent olecranon physis [2] . These observations strongly suggest that an operation is necessary to treat fracture of the persistent olecranon physis in adults [8] .…”

Surgical Treatment of Displaced Olecranon Fracture Through a Persistent Physis: Case Report and Review of the Literature

“…Several case series and case reports of painful persistent olecranon physes have been described, mostly in overhead athletes such as baseball players, 4,9,13,25,26,30 weight lifters, 38 and tennis players. 32 In our review of the literature, the prevalence of bilateral persistent olecranon physis was not well documented; however, almost all studies that included a contralateral elbow radiograph had complete fusion of the olecranon, as in our patient.…”

“…Although no anterior soft tissue release was performed, by closing the persistent physeal gap, there was likely a decrease in posterior olecranon fossa impingement allowing for improved elbow extension. In these cases, ORIF with or without bone grafting is typically performed after months of failed nonoperative treatment, 4,9,13,25,26,30,38 most commonly with a tension band construct, although nonoperative treatment has been successfully attempted in young patients. 25,32 Good outcomes have been obtained with ORIF, with a high healing rate.…”

“…25,32 Good outcomes have been obtained with ORIF, with a high healing rate. 4,9,13,25,26,30,38 The most common complications are hardware prominence and subsequent need for hardware removal. 4,13,25 Nonunion appears to be rare after ORIF of persistent nondisplaced olecranon physes.…”