Diagnosis and treatment of osteochondritis dissecans of the humeral capitellum

Abstract

Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. A plain anteroposterior radiograph with the elbow in 45° of flexion is essential for the diagnosis of an OCD lesion. The stability of OCD lesions is evaluated on plain radiographs, computed tomography, and magnetic resonance imaging (MRI). Imaging features of the unstable lesions are an epiphyseal closure of the capitellum or a lateral epicondyle, a displaced fragment, or irregular contours of the articular surface and a high signal interface on T2-weighted MRI. A stable lesion has the potential to be healed with conservative treatment. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. In addition, surgery should be performed for the lesions that cause pain during daily activities, have a locking phenomenon, or which are assessed by imaging as obviously unstable. Arthroscopic debridement/loose body removal can be performed for small lesions (≤12 mm in diameter). For large lesions (>12 mm), preservation and/or reconstruction of the articular surface should be selected, such as bone-peg fixation of the lateral part of the fragment and osteochondral autograft transplantation (OAT) from the knee. In the future directions, there is no comparative study of OAT from the knee and rib. In addition, little is known about its long-term outcome, or resulting osteoarthritis. A recent meta-analysis showed that grafts harvested from the knee may lead to donor site morbidity (7.8%). Thus, a novel cartilage tissue engineering approach is anticipated.

Osteochondrosis dissecans des Ellenbogengelenks

“…Als zweithäufigstes betroffenes Gelenk entspricht die OD am Ellenbogen etwa 6 % aller osteochondralen Läsionen [50]. Männer sind mit einem Verhältnis von 3:1 betont in der zweiten Lebensdekade signifikant häufiger betroffen [31]. Auch wenn die OD von direkt traumatisch-bedingten osteochondralen Läsionen im Kontext von Makrotraumen wie Ellenbogenfrakturen etc.…”

“…Wie bereits beschrieben tritt Als Diagnostikum zur Evaluation der Fragmentstabilität hat die Sonographie an Aufmerksamkeit ebenfalls gewonnen. Die Unterscheidung zwischen instabilen und stabilen Fragmenten zeigt sich hierbei durch eine chondrale Konturunterbrechung, wie bereits in mehreren Studien belegt werden konnte [31,57].…”

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

“…If radiographic improvement is observed and the patient is asymptomatic, sport-specific training can be reasonably resumed [3,17]. However, if the lesion is unchanged or worse, surgical treatment may be considered [17,24,25]. Longer or multiple trials of conservative treatment may be reasonable to attempt in patients with closed physes, especially if the lesions are of lower stage, given their high potential for spontaneous healing [24].…”

“…Mechanical symptoms are an indication that an anatomic barrier (e.g., osteochondral flap or loose body) is disrupting normal joint mechanics. Stable lesions do not impede the normal arc of ulnohumeral motion, while unstable lesions commonly restrict elbow motion by 20°or more [14,25]. Accordingly, these are unlikely to resolve without surgical intervention ( Fig.…”

“…While marrow-stimulating methods are sufficient for management of unstable lesions with a small footprint, OAT is preferable for reconstruction of unstable lesions of larger size, in patients with closed physes, or when the lateral buttress of capitellar cartilage is compromised. OCD lesion size of greater than 10-12 mm [25,35,49] or 50% of the capitellar articular surface are commonly reported thresholds for moving away from simple reparative techniques in favor of restorative a b procedures such as OAT or osteochondral allograft transplantation (OCA) [31,47,50]. Additionally, even small lesions may benefit from OAT or another chondral reconstructive option.…”