Osteochondral Lesions of the Elbow

Abstract

Osteochondral lesions of the elbow are injuries that disrupt the cartilage and subjacent bone, and they most commonly involve the capitellum. The staging, prognosis, and treatment of osteochondral lesions in the elbow are based on a combination of radiographic, magnetic resonance imaging, and arthroscopic findings. Radiographic staging includes the radiolucent, separation, and free (advanced) stages. MR imaging features of instability include cysts, osteochondral fracture, T2 hyperintense rim, subchondral plate defects, and fluid-filled osteochondral defects. Finally, arthroscopic grading of osteochondral lesions increases in severity based on findings of softened cartilage, cartilage fissuring, exposed bone, loose but nondisplaced fragments, and eventually displaced fragments resulting in intra-articular bodies. This pictorial review focuses on osteochondral lesions in the capitellum and trochlea including osteochondritis dissecans, Panner disease, and acute trauma.

Elbow MR arthrography with traction

“…6 Nevertheless, articular cartilage injury can be a source of troublesome elbow pain and is the main indication for MRA of the elbow. For example, osteochondritis dissecans of the capitellum is one of the leading causes of long-term elbow disability in young athletes.…”

“…[1][2][3][4][5][6][7] Evaluation of the elbow joint articular cartilage with MRA remains challenging, with a sensitivity of about 80% for the detection of all cartilage defects, although it is ,50% for superficial defects. 8 Improving the visibility of the articular cartilage is the first step to a more accurate evaluation of an articular cartilage injury, which will in turn improve patient management.…”

Radiographic Circularity of Capitellum and Its Relation to the Range of Motion

“…However poor prognosis occurs where large unstable fragments disturb the articular surface and reconstruction is required to obtain better results. Good results are seen where remodeling can occur as the capitellar growth plates remain open and where changes in the capitulum appear localized in terms of flattening or subchondral lesions [12]. In traumatic injury to the elbow, capitellar injury in association with radial head injury appears poorly tolerated and often leads to loss of flexion range and rotation [13].…”