Location of Osteochondritis Dissecans Lesions of the Capitellum

Johnson, Christine Cole; Roberts, Susanne M.; Mintz, Douglas N.; Fabricant, Peter D.; Hotchkiss, Robert N.; Daluiski, Aaron

doi:10.1016/j.jhsa.2018.03.017

Cited by 13 publications

(15 citation statements)

References 18 publications

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“…Lesion size and location influence OAT outcomes, with larger and more laterally located lesions considered more severe and difficult to treat [13, 27••, 40, 48, 49, 57]. Johnson et al [5] found roughly 1/3 of capitellar OCD lesions to be laterally located. When comparing 44 laterally located lesions to 43 centrally located lesions, Matsuura and colleagues [27••] found central lesions to fare better in terms of postoperative T&A scores, incidence of radial head subluxation, and RTP.…”

Section: Resultsmentioning

confidence: 99%

“…The most widely used classifications systems can be found in Table 1 and Table 2. Additionally, Johnson et al [5] recently developed a unique system of lesion localization based on a clock face that intends to more precisely describe lesion location. The intent of this system is to help facilitate intraoperative decision-making and permit longitudinal follow-up for clinical and research purposes.…”

Section: Classificationmentioning

confidence: 99%

“…The term osteochondritis dissecans (OCD) was originally coined by Konig in 1888 to describe the presence of intraarticular loose bodies without known antecedent trauma [1][2][3]. While the exact mechanism for OCD lesion formation remains unclear, a multi-factorial etiology-altered biomechanics, repetitive microtrauma, localized ischemia, and a genetic predisposition-is most likely [4][5][6][7]. When specifically assessing OCD of the capitellum, repetitive compression at the radiocapitellar articulation from either excessive valgus or axial loading is believed to play the predominant role [8].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

View full text Add to dashboard Cite

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“…Coronal lesion width was also expressed as a percentage of distal humeral articular surface width (Figure 1A), and coronal lesion location was expressed as distance lateral to the trochlear groove (Figure 1B). OCD location on sagittal reconstructions was expressed in degrees relative to the anterior humeral axis, as adapted from Johnson et al 9 (Figure 1C). OCD lesions were also classified according to the International Cartilage Research Society classification and Nelson grade.…”

Section: Methodsmentioning

confidence: 99%

“…(B) Quantification of coronal lesion location as the distance of the center of OCD (dot) lateral to the apex of the humeral trochlear (arrow). (C) Quantification of sagittal lesion location based on method described by Johnson et al 9 A circle of best fit is drawn on the trochlea on the sagittal slice where OCD is largest. The 0° axis is defined as a line starting from the center of the circle running parallel to the anterior humeral line.…”

Section: Methodsmentioning

confidence: 99%

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

2019

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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.

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Editorial Commentary: At Least 2 out of 3 Adolescent Athletes Can Return to Preinjury Sports After Marrow Stimulation for Osteochondritis Dissecans of the Elbow

Scanaliato,

Poehling,

Waterman

2024

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Location of Osteochondritis Dissecans Lesions of the Capitellum

Abstract: The clock-face localization system allows for precise description of capitellar OCD lesion location, which may facilitate intraoperative decision and longitudinal monitoring.

Cited by 13 publications

References 18 publications

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

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

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

Editorial Commentary: At Least 2 out of 3 Adolescent Athletes Can Return to Preinjury Sports After Marrow Stimulation for Osteochondritis Dissecans of the Elbow

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