Purpose
To (1) report the long-term outcomes associated with both operative and nonoperative
management of capitellar osteochondritis dissecans (OCD), (2) identify factors associated
with failure of nonoperative management, and (3) determine whether delay in surgery
affects final outcomes.
Methods
All patients who received a diagnosis of capitellar OCD from 1995-2020 within a geographic
cohort were included. Medical records, imaging studies, and operative reports were
manually reviewed to record demographic data, treatment strategies, and outcomes.
The cohort was divided into 3 groups: (1) nonoperative management, (2) early surgery,
and (3) delayed surgery. Delayed surgery (surgery ≥6 months after symptom onset) was
considered failure of nonoperative management.
Results
Fifty elbows with a mean follow-up period of 10.5 years (median, 10.3 years; range,
1-25 years) were studied. Of these, 7 (14%) were definitively treated nonoperatively,
16 (32%) underwent delayed surgery after at least 6 months of failed nonoperative
treatment, and 27 (54%) underwent early surgical intervention. When compared with
nonoperative management, surgical management resulted in superior Mayo Elbow Performance
Index pain scores (40.1 vs 33, P = .04), fewer mechanical symptoms (9% vs 50%, P < .01), and better elbow flexion (141° vs 131°, P = .01) at long-term follow-up. Older patients trended toward increased failure of
nonoperative management (P = .06). The presence of an intra-articular loose body predicted failure of nonoperative
management (P = .01; odds ratio, 13). Plain radiography and magnetic resonance imaging had poor
sensitivities for identifying loose bodies (27% and 40%, respectively). Differences
in outcomes after early versus delayed surgical management were not observed.
Conclusions
Nonoperative management of capitellar OCD failed 70% of the time. Elbows that did
not undergo surgery had slightly more symptoms and decreased functional outcomes compared
with those treated surgically. The greatest predictors of failure of nonoperative
treatment were older age and presence of a loose body; however, an initial trial of
nonoperative treatment did not adversely impact the success of future surgery.
Level of Evidence
Level III, retrospective cohort study.
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References
- Osteochondritis dissecans of the capitellum.Am J Sports Med. 2010; 38: 1917-1928
- Osteochondritis dissecans.J Bone Joint Surg Am. 1996; 78: 439-456
- A review of knowledge in osteochondritis dissecans: 123 Years of minimal evolution from Konig to the ROCK study group.Clin Orthop Relat Res. 2013; 471: 1118-1126
- The extraosseous and intraosseous arterial anatomy of the adult elbow.J Bone Joint Surg Am. 1997; 79: 1653-1662
- On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus.Acta Orthop Scand Suppl. 1959; 38: 1-232
- Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum.J Am Acad Orthop Surg. 2004; 12: 246-254
- Prevalence and clinical characteristics of osteochondritis dissecans of the humeral capitellum among adolescent baseball players.Am J Sports Med. 2014; 42: 1963-1971
- AOSSM early sport specialization consensus statement.Orthop J Sports Med. 2016; 42325967116644241
- When Is it too early for single sport specialization?.Am J Sports Med. 2016; 44: 234-241
- Youth sports specialization and musculoskeletal injury: A systematic review of the literature.Phys Sportsmed. 2016; 44: 257-262
- Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum.J Bone Joint Surg Am. 2007; 89: 1205-1214
- Nonoperative treatment for osteochondritis dissecans of the capitellum.Am J Sports Med. 2009; 37: 298-304
- Predictors of unsuccessful nonoperative management of capitellar osteochondritis dissecans.Am J Sports Med. 2019; 47: 2691-2698
- Osteochondritis dissecans lesions of the capitellum in overhead athletes: A review of current evidence and proposed treatment algorithm.Curr Rev Musculoskelet Med. 2019; 12: 1-12
- Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: Minimum three-year follow-up.Am J Sports Med. 2002; 30: 474-478
- Arthroscopic debridement of the humeral capitellum for osteochondritis dissecans: Radiographic and clinical outcomes.J Hand Surg Am. 2011; 36: 1333-1338
- Arthroscopic management of osteochondritis dissecans of the capitellum: Mid-term results in adolescent athletes.J Pediatr Orthop. 2010; 30: 8-13
- Internal fixation of unstable in situ osteochondritis dissecans lesions of the capitellum.J Pediatr Orthop. 2015; 35: 467-473
- The clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum of young athletes.J Shoulder Elbow Surg. 2011; 20: 813-818
- Capitellar osteochondritis dissecans lesions of the elbow: A systematic review of osteochondral graft reconstruction options.Arthroscopy. 2020; 36: 1747-1764
- Both debridement and microfracture produce excellent results for osteochondritis dissecans lesions of the capitellum: A systematic review.Arthrosc Sports Med Rehabil. 2021; 3: e593-e603
- Osteochondritis dissecans of the elbow. A long-term follow-up study.Clin Orthop Relat Res. 1992; 284: 156-160
- Nonoperative treatment of osteochondritis dissecans of the humeral capitellum.Am J Sports Med. 1999; 6: 728-732
- Use of a medical records linkage system to enumerate a dynamic population over time: The Rochester Epidemiology Project.Am J Epidemiol. 2011; 173: 1059-1068
- Osteochondritis dissecans of the talus and knee: Prospective comparison of MR and arthroscopic classifications.J Comput Assist Tomogr. 1990; 14: 804-808
- Long term outcome of osteochondritis dissecans of the humeral capitellum.Clin Orthop Relat Res. 1999; 363: 108-115
- Nonoperative treatment of osteochondritis dissecans of the humeral capitellum.Am J Sports Med. 1999; 27: 728-732
- Osteochondritis dissecans of the capitellum.J Trauma. 1982; 22: 53-55
- Arthroscopic treatment of osteochondritis dissecans of the capitellum.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 198-202
- Outcomes of arthroscopic treatment of osteochondritis dissecans of the capitellum and description of the technique.J Shoulder Elbow Surg. 2015; 24: 1607-1612
- Osteochondritis dissecans of the elbow: Excellent results in teenage athletes treated by arthroscopic debridement and microfracture.Croat Med J. 2012; 53: 40-47
- Clinical outcome after arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum.Am J Sports Med. 2017; 45: 2312-2318
- Outcomes and failure factors in surgical treatment for osteochondritis dissecans of the capitellum.J Pediatr Orthop. 2013; 33: 719-724
- Surgical treatment for osteochondritis dissecans of the humeral capitellum.J Shoulder Elbow Surg. 2010; 19: 31-37
- Outcomes of arthroscopic surgical treatment of osteochondral lesions of the elbow in pediatric and adolescent athletes.Orthop J Sports Med. 2020; 82325967120963054
- Conservative treatment for osteochondrosis of the humeral capitellum.Am J Sports Med. 2008; 36: 868-872
- Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Surgical technique.J Bone Joint Surg Am. 2008; 90 (suppl 2, pt 1): 47-62
- Successful nonoperative treatment of osteochondritis dissecans of the humeral capitellum in a young baseball player with advanced skeletal maturity.Prog Rehabil Med. 2021; 620210044
- The arthroscopic management of osteochondritis dissecans of the adolescent elbow.Arthroscopy. 1998; 14: 797-803
- Imaging and classification of osteochondritis dissecans of the capitellum: X-ray, magnetic resonance imaging or computed tomography?.Shoulder Elbow. 2019; 11: 129-136
Article info
Publication history
Published online: February 24, 2023
Accepted:
January 5,
2023
Received:
October 5,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: M.E.M. receives personal fees and nonfinancial support from Elsevier, outside the submitted work. J.S-S. receives personal fees from Acumed, American Shoulder and Elbow Surgeons, Elsevier, Exactech, Journal of Shoulder and Elbow Surgery, Oxford University Press, PSI, Stryker, and Wright Medical Technology; receives other support from Acumed, Precision CS, and Wright Medical Technology; and owns stock and stock options in Precision CS, outside the submitted work. S.W.O. receives personal fees from Acumed, Aircast, and Wright Medical Technology and receives nonfinancial support from Acumed and Wright Medical Technology, outside the submitted work. C.L.C. receives personal fees from Arthrex, Zimmer Biomet, and Gemini and receives nonfinancial support from Arthrex, Zimmer Biomet, and Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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