Background:
Osteochondritis dissecans (OCD) of the capitellum occurs in skeletally immature athletes, and most likely results from repetitive trauma during overhead activities. Treatment may consist of activity modifications, internal fixation, abrasion chondroplasty, microfracture, antegrade drilling, retrograde drilling, osteochondral autograft or allograft implantation, chondrocyte implantation, and rib autograft through arthroscopy or arthrotomy. One treatment modality has not been proven to be clearly more effective than the others. This study was undertaken to evaluate our treatment regimen that utilized arthroscopic-assisted treatments of capitellar OCD, including removal of loose bodies, antegrade or retrograde drilling, and chondroplasty in the pediatric population.
Methods:
All patients treated arthroscopically for a diagnosis of capitellar OCD over a 5-year period, were retrospectively reviewed. All were asked to return for follow-up questionnaire and radiographs. Exclusion criteria included those lost to follow-up. Demographics were recorded and range of motion was evaluated preoperatively and at most recent follow-up for flexion, extension, supination, and pronation. Preoperative and the most recent anterior/posterior and lateral radiographs of the elbow were reviewed. A 200-point elbow rating scale was used to assess patient outcomes. The arthroscopic appearance of the lesion was graded. Changes in preoperative to postoperative range of motion and size of lesion were compared using repeated measures analysis of variation.
Results:
There were 13 elbows in 12 patients; only 3 of the injuries occurred acutely. Mean age at the time of surgery was 13.1±1.07 (range, 10.8 to 14.6 y). Mean follow-up was 23.4±16.7 months (range, 2 to 60 mo). There were 3 grade I lesions, 2 grade II lesions, 1 grade IV lesion, and 7 grade V lesions. Seven of the lesions underwent transhumeral drilling, 2 transarticular drilling, 3 loose body removals, and 2 had only debridement. There were no postoperative infections or neurovascular injuries. Three of the elbows (20%) required eventual arthrotomy at a mean of 27.9 months after the index procedure. At final follow-up, 67% reported no pain and 33% reported occasional pain. No patients reported any swelling. Eighty-three percent reported no locking or catching and 17% reported occasional locking or catching. No patients reported any activity restrictions. The mean subjective score was 96±6 of 100 and the mean objective score was 100 of 100. Mean extension improved significantly from −17 to −7 degrees (P<0.001).
Conclusions:
Treatment of children with OCD lesions of the capitellum with arthroscopic-assisted debridement and fenestration of the sclerotic rim (trans-humeral if overlaying cartilage is intact), plus fixation of the overlaying cartilage if not securely attached to the subchondral bone permits the return to physical activity, but may not allow return to the injury-inducing sport. Our short-term outcomes obtained using this regimen found this technique to be safe and reliable, but other interventions may be required if continued disability persists.
