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

Abstract

Background: Osteochondral injuries of the elbow are limiting and affect the ability of pediatric and adolescent athletes to participate in sports. Purpose: To report short- and midterm outcomes on athletes undergoing microfracture or fragment fixation of osteochondral elbow lesions and evaluate the effects thereof on sporting activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study analyzing patients who underwent surgical treatment via microfracture or fragment fixation for osteochondral elbow lesions. Patients were treated at a single institution by a single surgeon between 2012 and 2019. Diagnosis was confirmed with magnetic resonance imaging, and patients were indicated for surgery after having persistent symptoms despite trialing rest, immobilization, and/or activity restriction for at least 3 months. Demographic data including sports of choice were collected preoperatively. Imaging and intraoperative findings were documented, and any complications were noted. Range of motion (ROM) was compared pre- to postoperatively. Return-to-sport evaluation included the ability to play the preoperative sport of choice. Results: In total, 23 patients (25 elbows) were included with a mean follow-up of 23.5 months (range, 6-60.3 months) and a mean age of 13.8 years. Of 25 lesions, 20 (80%) were on the athlete’s dominant side. There was significant improvement from pre- to postoperative ROM, including extension (mean ± SD, 6.4° ± 5.3° to 0.04° ± 0.2°; P < .00001), flexion (129.2° ± 10.6° to 138.6° ± 4.4°; P = .00013), and arc of ROM (122.6° ± 13.2° to 138.6° ± 4.4°; P < .00001). Mean lesion size was 81.9 ± 59.3 mm2 (range, 15-225 mm2). All elbows demonstrated radiographic healing postoperatively. Mean time to release to sport was 4.48 ± 1.38 months (range, 2.5-8 months). Six (26.1%) patients changed or stopped their preoperative sporting activity, including 2 of 4 gymnasts and 4 of 11 baseball players. Conclusion: Arthroscopic technique with lesion debridement and microfracture or fixation appears safe and results in radiographic healing; however, with these techniques, there remains a high rate of inability to return to sport in patients involved in higher-demand upper extremity activity, such as baseball and gymnastics. Further treatment strategies, including cartilage restoration procedures, may be warranted in this population.

Treatment of Osteochondritis Dissecans of the Capitellum Using BioCartilage in Adolescent Athletes Results in Safe and Timely Return to Play

“…Both patients returned to playing baseball at 5 months; however, 1 patient stopped pitching. 19 This procedure performed arthroscopically is technically demanding and is best left in the hands of a skilled elbow arthroscopist. However, any competent orthopaedic surgeon should be capable of performing our technique through a small, 2-inch incision.…”

“…Allahabadi and colleagues in 2020 reported excellent postoperative ROM of 2 patients treated with arthroscopic microfracture and BioCartilage implantation. Both patients returned to playing baseball at 5 months; however, 1 patient stopped pitching 19. This procedure performed arthroscopically is technically demanding and is best left in the hands of a skilled elbow arthroscopist.…”

Management of Capitellar Osteochondritis Dissecans

“…Previous studies evaluating arthroscopic debridement for capitellar OCD have shown favorable outcomes, which further suggest its potential as a first-line operative strategy. Allahabadi et al 29 evaluated outcomes following arthroscopy with microfracture in 26 adolescent athletes and found radiographic healing in all operative elbows. Only 6 athletes modified or discontinued their preoperative level of activity.…”

Imaging the Postoperative Elbow

“…9). 24,25 Alternatively, treatment can include fixation of an unstable osteochondral fragment to the underlying bone using wire or a self-tapping screw. Newer treatments include cartilage repair.…”