Predictors of Unsuccessful Nonoperative Management of Capitellar Osteochondritis Dissecans

Abstract

Background: Osteochondritis dissecans of the humeral capitellum (capitellar OCD) is a common injury among adolescent throwing athletes. Some younger patients with incomplete maturity of the epiphysis and early-stage capitellar OCD are good candidates for nonoperative treatment. However, during initial examination, predicting the need for surgical treatment in patients with capitellar OCD is difficult. Purpose: To perform multivariate ordered logistic regression analysis of data obtained from patients’ medical records and images on initial examination and identify the predictors of unsuccessful nonoperative management of capitellar OCD. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: This study included 245 elbows with capitellar OCD (all male; mean age, 14 years [range, 10-27 years]). Patients were divided into 3 groups comprising 148 elbows requiring an immediate operation on initial examination, 48 requiring nonsurgical treatment, and 49 requiring an operation after nonoperative management. Baseline data and radiographic parameters, such as lesion location, lesion size, modified Minami classification, radial head size, skeletal age difference between both elbows on initial examination, lesion size on computed tomography, and staging on magnetic resonance imaging, were retrospectively reviewed. Univariate and multivariate ordered logistic regression analyses of spontaneous healing of the lesion were conducted. Results: Univariate logistic regression analysis showed that radial head enlargement and skeletal age difference were significantly associated with spontaneous healing. In multivariate ordered logistic regression analysis, radial head enlargement (anteroposterior and lateral) and skeletal age difference were significant predictors of lack of spontaneous healing (odds ratio [OR], 2.76, P =.025; OR, 7.92, P =.026; and OR, 1.84, P =.0089, respectively). Conclusion: To predict spontaneous healing in the moderate stage, plain radiographs would be important to evaluate radiocapitellar congruity and skeletal age. This study showed that preoperative radiographic findings of radial head enlargement and advanced skeletal age of the throwing side compared with that of the nonthrowing side were predictors of advanced-stage capitellar OCD. Despite several limitations, the statistical significance and correlations herein provide important information on preoperative surgical planning to surgeons.

Predictors of Failure of Return to Play in Youth Baseball Players After Capitellar Osteochondritis Dissecans: Focus on Elbow Valgus Laxity and Radiocapitellar Congruity

“…Recently, the predictors of failure in the nonoperative management of capitellar OCD have been discussed. 4,8,16 Indeed, Takahara et al 16 and Matsuura et al 8 reported that youth patients with incomplete maturity of the epiphysis and early-stage capitellar OCD are good candidates for nonoperative treatment. In agreement with these previous studies, 8,16 we found a relationship between successful OCD rehabilitation and OCD classification: there was a 4-fold greater success rate for early-stage capitellar OCD.…”

“…In agreement with these previous studies, 8,16 we found a relationship between successful OCD rehabilitation and OCD classification: there was a 4-fold greater success rate for early-stage capitellar OCD. Furthermore, Funakoshi et al 4 showed that preoperative radiographic findings of radial head enlargement and advanced skeletal age of the throwing side compared with that of the nonthrowing side were predictors of advanced-stage capitellar OCD. Moreover, this study found that radiocapitellar congruity was important to the success of nonoperative management for capitellar OCD.…”

“…When capitellar OCD is diagnosed in youths, long-term rest is needed before the patients are fit to return to play baseball. 4 Therefore, it is important to predict the convalescence for nonoperative treatment of capitellar OCD. Some studies have investigated the predictors of failure in the nonoperative management of capitellar OCD.…”

“…Indeed, Takahara et al 16 reported that patients with stable lesions and open capitellar physes have better healing with nonoperative treatment, and Matsuura et al 8 reported that nonoperative management was associated with radiographic healing in 91% of patients with early-stage capitellar OCD. Furthermore, Funakoshi et al 4 showed that preoperative radiographic findings of radial head enlargement and advanced skeletal age of the throwing side compared with that of the nonthrowing side were negative predictors of nonoperative management. The results of these studies suggest that youth patients with incomplete maturity of the epiphysis, early-stage capitellar OCD, and radiocapitellar congruity are good candidates for nonoperative treatment.…”

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.…”