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Arthroscopic Management of Osteochondritis Dissecans of the Capitellum: Mid-term Results in Adolescent Athletes

Jones, Kristofer J. MD*; Wiesel, Brent B. MD; Sankar, Wudbhav N. MD; Ganley, Theodore J. MD

Journal of Pediatric Orthopaedics: January-February 2010 - Volume 30 - Issue 1 - p 8-13
doi: 10.1097/BPO.0b013e3181c3be83
Sports Medicine
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Background The optimal treatment of osteochondritis dissecans (OCD) of the capitellum in adolescent athletes remains challenging. The purpose of this study was to investigate the mid-term results of arthroscopic treatment of OCD of the capitellum in a series of adolescents.

Methods We identified 25 consecutive patients at our institution that underwent arthroscopic treatment for OCD of the capitellum since 1999. Ten elbows were treated by arthroscopic debridement and drilling alone, whereas 12 elbows required additional mini-arthrotomies for bone grafting or the removal of large loose bodies after arthroscopy. The clinical charts and operative reports of these patients were retrospectively reviewed for relevant clinical information including age, sport, character of symptoms, preoperative and postoperative range of motion, return to sport, and postoperative complications. Twenty-one patients (22 elbows) were reached to determine their current elbow function and athletic activity using the Single Assessment Numerical Evaluation score.

Results The average age of the patients in our series was 13.1 years. All patients participated in organized athletics that involved the upper extremity and had undergone an average of 10.2 months of nonoperative treatment before surgery. At a mean follow-up of 48 months, the patients gained an average of 17 degrees of extension and 10 degrees of flexion after surgery. Both the improvement in flexion and extension were statistically significant compared with the preoperative range of motions (P=0.001, P=0.01). When patients were asked to rate their elbow function from 0% to 100% using the Single Assessment Numerical Evaluation score, the average rating was 87%. Eighteen of 21 patients (86%) returned to participate in their sport at their preinjury level.

Conclusion Arthroscopic management of capitellar OCD in adolescent athletes results in significantly improved range of motion and a high rate of return to athletics. Accompanying arthrotomy may be required for large loose body removal or bone grafting.

Level of Evidence Level IV (case series).

*Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY

Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC

Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA

There were no funding sources utilized for the completion of this study.

Reprints: Kristofer J. Jones, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021. E-mail: jonesk@hss.edu.

This study was presented at the 2009 Annual American Academy of Orthopaedic Surgeons Meeting as a podium presentation in the pediatric sports medicine section.

None of the authors received financial support for this study.

© 2010 Lippincott Williams & Wilkins, Inc.