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

Abstract

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

Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes

“…This is in line with prior data suggesting that patients with open physes or those who are younger have better outcomes with operative and nonoperative management. 3,9,15,19,20 We observed significant improvements in ROM in flexion, extension, and arc of elbow motion in this cohort, without difference with respect to surgical technique or sporting activities. Prior authors have also demonstrated improvements in flexion and/or extension ROM.…”

“…This is in line with prior data suggesting that patients with open physes or those who are younger have better outcomes with operative and nonoperative management. 3,9,15,19,20…”

Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects

“…However, a meta-analysis by Logli et al. 8 showed that among 444 patients, there was only 1 knee donor site–related complication, which was a superficial wound infection.…”

“…Donor-site morbidity is a concern, so the senior surgeon often backfills harvest sites with allograft in competitive athletes. However, a meta-analysis by Logli et al 8 showed that among 444 patients, there was only 1 knee donor siteerelated complication, which was a superficial wound infection.…”

Early Radiographic Healing and Functional Results After Autologous Osteochondral Grafting for Osteochondritis Dissecans of the Capitellum: Introduction of a New Magnetic Resonance Imaging–Based Scoring System

“…Several surgical options are available for the treatment of COCDs, including debridement, microfracture, fragment fixation, and autologous osteochondral grafting (OG). 14 Cohort studies have suggested that single-plug OG can be used to achieve good pain relief and improved functional outcomes. 2,19,26,28 Additionally, use of OG in other joints has been shown to lead to superior outcomes as compared with use of microfracture and debridement.…”