Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

Bexkens, Rens; Ende, Kim I M van den; Ogink, Paul T.; Bergen, Christiaan J. A. van; Bekerom, Michel P.J. van den; Eygendaal, Denise

doi:10.1177/0363546517704842

Cited by 63 publications

(67 citation statements)

References 44 publications

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“…Thirdly, it is difficult to preserve and fix all small pieces of the articular surface when the fractures are comminuted. If all small pieces of the articular surface are not retained, the morphology of the articular surface of the humeroradial joint will be altered, thereby resulting in pain, instability, loss of motion, and traumatic arthritis in some patients [7,8,[18][19][20]. Treatment options have evolved from fragment excision and closed reduction/immobilization to ORIF in order to achieve stable anatomic reduction, restore articular congruity, and initiate early motion [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Anti-sliding plate technique for coronal shear fractures of the distal humerus

Song

Wang

et al. 2020

J Orthop Surg Res

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Purpose: The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. Methods: Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. Results: Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3°(0-15°) for extension and 136°(90-150°) for flexion. Conclusions: The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome.

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Section: Discussionmentioning

confidence: 99%

Anti-sliding plate technique for coronal shear fractures of the distal humerus

Song

Wang

et al. 2020

J Orthop Surg Res

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“…Bexkens et al (21) han publicado recientemente su experiencia en 75 codos (71 pacientes) con ODC tratados mediante desbridamiento artroscópico, microfracturas y extirpación de cuerpos libres con buenos resultados clínicos, aunque tan solo el 55% de los pacientes pudo retornar a su actividad deportiva previa al mismo nivel y el 25% no volvió a realizar deporte por los síntomas residuales en el codo.…”

Section: Resultsunclassified

Tratamiento artroscópico de la osteocondritis disecante del codo

Delgado¹,

Medrano²,

López³

et al. 2018

REACA

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RESUMEN Objetivo: presentar conceptos básicos de etiología, exploración, clasificación de la osteocondritis disecante del codo (ODC) y el tratamiento artroscópico de la misma. Material y métodos: se realizó una búsqueda exhaustiva de literatura. Han sido revisados estudios clínicos, biomecánicos, anatómicos y de imágenes relevantes junto con artículos de revisión recientes y series de casos publicados sobre ODC y tratamiento artroscópico. Resultados: la ODC es una afección dolorosa, que a menudo afecta a los jóvenes deportistas. Se conocen la etiología, los factores de riesgo, el diagnóstico y la eficacia del tratamiento disponible. La exploración clínica y la resonancia magnética (RM) son claves para el diagnóstico. El tratamiento se basa en la clasificación de la International Cartilage Repair Society (ICRS). El tratamiento más utilizado es la resección del fragmento y microperforaciones. No hay evidencia de que un tratamiento sea superior a otro. Se han descrito mejores resultados en niños. El peor resultado se obtiene en los pacientes deportistas de alto rendimiento. Conclusiones: en estadios iniciales se debe disminuir la carga deportiva y realizar medidas conservadoras.

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“…2). Debridement involves the removal of unstable cartilage and necrotic bone via a curette or shaver [29]. Microfracture involves the use of an awl to impact below the level of the subchondral bone enough to allow marrow elements to egress into the lesion bed.…”

Section: Description and Indicationsmentioning

confidence: 99%

Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm

Logli

Bernard

O’Driscoll

et al. 2019

Curr Rev Musculoskelet Med

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Purpose of the Review To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience. Recent Findings Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. These studies have focused on understanding how lesion characteristics such as size, location, and appearance on advanced imaging can predict treatment success. Current literature continues to support nonoperative management for stable lesions. Operative intervention is generally required for unstable lesions and treatment strategies are largely dictated by lesion size and location: debridement or reparative techniques for small lesions while larger lesions or those in high-stress locations are better served by bone and/or cartilage restoration procedures. There has been a rising interest in the use of allograft materials and cellbased therapies. Summary Overhead athletes are uniquely predisposed to capitellar OCD due to the nature of forces applied to the radiocapitellar joint during repeated activity in the overhead position. Despite improvements in operative techniques, successful use of alternative graft materials, and a better understanding of how lesion characteristics influence results, there is still much to learn about this challenging disorder. Future research should focus on comparing operative techniques, refining their indications, and further developing a reliable treatment algorithm that best serves the overhead athlete. Keywords Osteochondritis dissecans (OCD). Humeral capitellum. Overhead athlete. Elbow pain. Baseball players. Gymnasts This article is part of the Topical Collection on Injuries in Overhead Athletes

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Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

Abstract: Arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans provide good clinical results, especially in patients with open growth plate, loose body removal, and shorter duration of symptoms. However, only 62% of patients in this study returned to sports.

Cited by 63 publications

References 44 publications

Anti-sliding plate technique for coronal shear fractures of the distal humerus

Anti-sliding plate technique for coronal shear fractures of the distal humerus

Tratamiento artroscópico de la osteocondritis disecante del codo

Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm

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