Nonoperative Treatment for Osteochondritis Dissecans of the Capitellum

Mihara, Kenichi; Tsutsui, Hiroaki; Nishinaka, Naoya; Yamaguchi, Ken

doi:10.1177/0363546508324970

Cited by 151 publications

(135 citation statements)

References 23 publications

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“…Stable lesions can be managed successfully with non-operative measures including rest and activity modification. Factors associated with a good prognosis include early lesions, patients with open capitellar growth plates [26], and localized subchondral bone flattening without fragmentation [27,28]. However, healing with non-operative management becomes very unlikely in those with closed growth plates and lesion instability even without displacement [26,28,27,29].…”

Section: Classificationmentioning

confidence: 99%

Elbow Injuries in the Adolescent Thrower

Griffith

Kercher

Willimon

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of Review With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Recent Findings Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. Summary With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes.

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Section: Classificationmentioning

confidence: 99%

Elbow Injuries in the Adolescent Thrower

Griffith

Kercher

Willimon

et al. 2018

Curr Rev Musculoskelet Med

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“…This involves immediate cessation of aggravating activities that load the radiocapitellar joint, i.e., throwing, gymnastics, weightlifting [6,7,19,40,41]. Some authors advocate the use of a hinged elbow brace for a period of 1-6 weeks in the initial resting period to allow intermittent range of motion exercises to prevent stiffness, while others recommend rest without immobilization [6,19].…”

Section: Non-operative Treatmentmentioning

confidence: 99%

“…After an initial period of rest, physical therapy is initiated avoiding strengthening until resolution of symptoms [19]. Most athletes who respond to conservative management may start gentle overhead throwing at 3-4 months with return to play at 6 months [6,7,19,41].…”

Section: Non-operative Treatmentmentioning

confidence: 99%

Osteochondritis dissecans of the elbow

Churchill

Muñoz

Ahmad

2016

Curr Rev Musculoskelet Med

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Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch, and a tenuous vascular supply of the capitellum. Recent literature reveals that the prevalence is likely higher than previously thought. This, in conjunction with increased levels of athletic competition in children at younger ages, has fed the recent interest in this topic. The literature continues to show that non-operative treatment is still successful for stable lesions. Unstable lesions, therefore, have been the focus of the new literature regarding operative management and outcomes. The aim of this paper is to provide a summary of current literature and an up-to-date approach to the diagnosis, evaluation, and treatment of osteochondritis dissecans of the capitellum.

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“…38 Similarly, only 50% of patients treated nonoperatively with a closed physis in the series of Mihara et al demonstrated healing. 25 Aside from unstable lesions, surgical management is usually reserved for patients who fail 6 months of nonoperative management. Various surgical treatments have been proposed, including drilling, microfracture surgery, debridement, fragment excision, loose body removal, and OAT.…”

Section: Classificationmentioning

confidence: 99%

Current Concepts

Kirsch

Thomas

Bedi

et al. 2016

Hand (New York, N,Y.)

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Background: Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology, risks factors, diagnosis, and efficacy of the available treatment options has expanded over recent years, however remains suboptimal. Recent data on patient-reported outcomes following osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the capitellum have been promising but limited. This review seeks to critically analyze and summarize the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. Methods: A comprehensive literature search was conducted. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Combinations of keywords and controlled vocabulary terms were utilized in order to cast a broad net. Relevant clinical, biomechanical, anatomic and imaging studies were reviewed along with recent review articles, and case series. Results: Forty-three articles from our initial literature search were found to be relevant for this review. The majority of these articles were either review articles, clinical studies, anatomic or imaging studies or biomechanical studies. Conclusions: Current evidence suggests that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum.

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Nonoperative Treatment for Osteochondritis Dissecans of the Capitellum

Cited by 151 publications

References 23 publications

Elbow Injuries in the Adolescent Thrower

Elbow Injuries in the Adolescent Thrower

Osteochondritis dissecans of the elbow

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