Osteochondritis Dissecans of the Humeral Capitellum

Abstract

Background:There is a paucity of information regarding the effect of lesion location on surgical outcomes in the treatment of osteochondritis dissecans (OCD) of the humeral capitellum.Purpose:To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum.Study Design:Systematic review; Level of evidence, 4.Methods:All studies from the past 20 years were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum.Results:Six studies met the inclusion criteria. Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes. There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin. The failure rate for nonreconstructive operative management for lateral lesions was noted to be significant, as failure rates for peg fixation of lateral lesions was seen to be as high as 44% (4/9) in one of the studies.Conclusion:Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, are limited. The literature suggests that lesions located on the lateral capitellum—particularly those involving the lateral cartilage margin—require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location as a factor influencing surgical decision making.

Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes

“…24,25 A recent systematic review reported that uncontained lesions located on the lateral capitellum require more aggressive surgical management than those located centrally or medially. 16 OAT or mosaicplasty involves harvesting viable subchondral bone and cartilage plugs from a low weightbearing portion of a joint and transferring them to the site of the cartilage injury. Aligning the plugs flush with the native cartilage is key, and when performed, results in normal contact pressures with the joint.…”

Osteochondritis dissecans of the elbow: state of the art

“…Nevertheless, their conclusion was that larger studies with enhanced methodological quality and longer follow-up should be performed to support this conclusion 21. A second systematic review on the location of OCD lesions of the capitellum suggests that lesions located on the lateral capitellum, particularly those involving the lateral cartilage margin, require more aggressive surgical management than those located medially22 (box 1).

Key articles, according to the authors, on osteochondritis dissecans (OCD) of the elbow

Minami23 described one of the first, relatively large series, with 25 cases of OCD of the elbow.

Bauer et al 19 investigated elbow degeneration among 31 OCD patients at a mean follow-up of 23 years.

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Current Concepts

“…Recent literature suggests that the location and size of OCD lesions are of primary importance when determining optimal operative † References 9, 15, 19, 23, 25, 28, 31, 36-38, 43. treatment. 2,19,26,38,42 The location of the lesion is likely the most important factor for considering OAT. Several authors have suggested that lateral capitellar lesions are more debilitating, causing patients to be more symptomatic preoperatively.…”