Abstract
Osteochondritis dissecans of the elbow is characterized by disruption of the articular surface and subchondral bone, likely due to a combination of tenuous vascularity of the articular surface and repetitive stress exerted upon the vulnerable epiphysis of the young adolescent patient. This condition is most common among throwing athletes and most frequently affects the capitellum, as significant compressive force is exerted upon the radiocapitellar articulation in throwers. These patients present with insidious onset of lateral elbow pain and often demonstrate a flexion contracture on examination. It is imperative to include an examination for concomitant pathology that can affect the throwing elbow, including valgus extension overload and ulnar collateral ligament disruption. Radiographs demonstrate radiolucency, flattening, fragmentation, or formation of loose bodies. Cyst formation or linear increased signal at the periphery of the lesion suggests instability of the lesion. Patients with open physes, near-normal range of motion, and a stable lesion on imaging can be treated conservatively with a period of absolute rest and careful rehabilitation. Those patients that fail conservative management or skeletally mature patients who present with a frankly unstable lesion on imaging and a significant flexion contracture may instead require operative intervention. Treatment options include arthroscopic debridement with or without microfracture or drilling, fragment fixation, osteochondral autograft reconstruction, autologous chondrocyte implantation, or distal humeral osteotomy. Arthroscopic debridement represents a common first-line treatment for most patients, with reasonable results. However, larger lesions accounting for more than 50 % of capitellar width, or those without a stable lateral border, are less effectively treated with an arthroscopic approach. For these cases, osteochondral autograft has shown promise in restoring the hyaline cartilage architecture and in reestablishing the lateral shoulder of uncontained lesions. By tailoring the treatment strategy to each unique patient and lesion, improvement in pain, increased range of motion, and return to sport can be achieved.
References
Edmonds EW, Polousky J. 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(4):1118–26.
Baker 3rd CL, Baker Jr CL, Romeo AA. Osteochondritis dissecans of the capitellum. J Should Elb Surg/Am Should Elb Surg. 2010;19(2 Suppl):76–82.
Konig F. Uber freie Korper in den gelenken. Deut Z Chir. 1888;27(1):90–109.
Schenck Jr RC, Athanasiou KA, Constantinides G, Gomez E. A biomechanical analysis of articular cartilage of the human elbow and a potential relationship to osteochondritis dissecans. Clin Orthop Relat Res. 1994;299:305–12.
Kusumi T, Ishibashi Y, Tsuda E, Kusumi A, Tanaka M, Sato F, et al. Osteochondritis dissecans of the elbow: histopathological assessment of the articular cartilage and subchondral bone with emphasis on their damage and repair. Pathol Int. 2006;56(10):604–12.
Haraldsson S. On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand Suppl. 1959;38:1–232.
Baumgarten TE, Andrews JR, Satterwhite YE. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med. 1998;26(4):520–3.
Takeda H, Watarai K, Matsushita T, Saito T, Terashima Y. A surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum in adolescent baseball players. Am J Sports Med. 2002;30(5):713–7.
Byrd JW, Jones KS. Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up. Am J Sports Med. 2002;30(4):474–8.
Mihara K, Suzuki K, Makiuchi D, Nishinaka N, Yamaguchi K, Tsutsui H. Surgical treatment for osteochondritis dissecans of the humeral capitellum. J Should Elb Surg/Am Should Elb Surg. 2010;19(1):31–7.
Mihara K, Tsutsui H, Nishinaka N, Yamaguchi K. Nonoperative treatment for osteochondritis dissecans of the capitellum. Am J Sports Med. 2009;37(2):298–304.
Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 1998;14(8):797–803.
Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007;89(6):1205–14.
Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up. Am J Sports Med. 2006;34(5):714–20.
Kijowski R, De Smet AA. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. Skeletal Radiol. 2005;34(5):266–71.
Zbojniewicz AM, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014;33(2):221–50.
Takahara M, Ogino T, Takagi M, Tsuchida H, Orui H, Nambu T. Natural progression of osteochondritis dissecans of the humeral capitellum: initial observations. Radiology. 2000;216(1):207–12.
Ahmad CS, Conway JE. Elbow arthroscopy: valgus extension overload. Instr Course Lect. 2011;60:191–7.
Iwasaki N, Kamishima T, Kato H, Funakoshi T, Minami A. A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes. Am J Sports Med. 2012;40(3):624–30.
Kijowski R, De Smet AA. MRI findings of osteochondritis dissecans of the capitellum with surgical correlation. AJR Am J Roentgenol. 2005;185(6):1453–9.
Claessen FM, van den Ende KI, Doornberg JN, Guitton TG, Eygendaal D, van den Bekerom MP, et al. Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography. J Should Elbow Surg/Am Should Elbow Surg. 2015;24(10):1613–8.
Takenaga T, Goto H, Nozaki M, Yoshida M, Nishiyama T, Otsuka T. Ultrasound imaging of the humeral capitellum: a cadaveric study. J Orthop Sci: Off J Jpn Orthop Assoc. 2014;19(6):907–12.
Minami M, Nakashita K, Ishii S, et al. Twenty-five cases of osteochondritis dissecans of the elbow. Rinsho Seikei Geka. 1979;14:805–10.
De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol. 1996;25(2):159–63.
Brittbert Mea. International Cartilage Repair Society Cartilage Injury Evaluation Package. http://www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf. 2000.
Takahara M, Mura N, Sasaki J, Harada M, Ogino T. 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.
Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Am J Sports Med. 1999;27(6):728–32.
Pill SG, Ganley TJ, Milam RA, Lou JE, Meyer JS, Flynn JM. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children. J Pediatr Orthop. 2003;23(1):102–8.
Matsuura T, Kashiwaguchi S, Iwase T, Takeda Y, Yasui N. Conservative treatment for osteochondrosis of the humeral capitellum. Am J Sports Med. 2008;36(5):868–72.
Brownlow HC, O’Connor-Read LM, Perko M. Arthroscopic treatment of osteochondritis dissecans of the capitellum. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2006;14(2):198–202.
Lewine EB, Miller PE, Micheli LJ, Waters PM, Bae DS. Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2015 [a head of print].
Rahusen FT, Brinkman JM, Eygendaal D. Results of arthroscopic debridement for osteochondritis dissecans of the elbow. Br J Sports Med. 2006;40(12):966–9.
Tis JE, Edmonds EW, Bastrom T, Chambers HG. Short-term results of arthroscopic treatment of osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop. 2012;32(3):226–31.
Harada M, Ogino T, Takahara M, Ishigaki D, Kashiwa H, Kanauchi Y. Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum. J Should Elb Surg/Am Should Elb Surg. 2002;11(4):368–72.
Hennrikus WP, Miller PE, Micheli LJ, Waters PM, Bae DS. Internal fixation of unstable in situ osteochondritis dissecans lesions of the capitellum. J Pediatr Orthop. 2015;35(5):467–73.
Iwasaki N, Kato H, Ishikawa J, Masuko T, Funakoshi T, Minami A. Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes. J Bone Joint Surg Am. 2009;91(10):2359–66.
Iwasaki N, Kato H, Ishikawa J, Masuko T, Funakoshi T, Minami A. Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes: surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 2):208–16.
Iwasaki N, Kato H, Ishikawa J, Saitoh S, Minami A. Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients. Am J Sports Med. 2006;34(8):1233–9.
Lyons ML, Werner BC, Gluck JS, Freilich AM, Dacus AR, Diduch DR, et al. Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes. J Should Elb Surg/Am Should Elb Surg. 2015;24(7):1098–105.
Maruyama M, Takahara M, Harada M, Satake H, Takagi M. Outcomes of an open autologous osteochondral plug graft for capitellar osteochondritis dissecans: time to return to sports. Am J Sports Med. 2014;42(9):2122–7.
Nishinaka N, Tsutsui H, Yamaguchi K, Uehara T, Nagai S, Atsumi T. Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum. J Should Elb Surg/Am Should Elb Surg. 2014;23(12):1888–97.
Shimada K, Tanaka H, Matsumoto T, Miyake J, Higuchi H, Gamo K, et al. Cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. J Bone Joint Surg Am. 2012;94(11):992–1002.
Shimada K, Yoshida T, Nakata K, Hamada M, Akita S. Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow. Clin Orthop Relat Res. 2005;435:140–7.
Zlotolow DA, Bae DS. Osteochondral autograft transplantation in the elbow. J Hand Surg. 2014;39(2):368–72.
Sato M, Ochi M, Uchio Y, Agung M, Baba H. Transplantation of tissue-engineered cartilage for excessive osteochondritis dissecans of the elbow. J Should Elb Surg/Am Should Elb Surg. 2004;13(2):221–5.
Kiyoshige Y, Takagi M, Yuasa K, Hamasaki M. Closed-Wedge osteotomy for osteochondritis dissecans of the capitellum. A 7- to 12-year follow-up. Am J Sports Med. 2000;28(4):534–7.
Davis JT, Idjadi JA, Siskosky MJ, ElAttrache NS. Dual direct lateral portals for treatment of osteochondritis dissecans of the capitellum: an anatomic study. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2007;23(7):723–8.
Hirahara AM, Mueller Jr KW. BioCartilage: a new biomaterial to treat chondral lesions. Sports Med Arthrosc Rev. 2015;23(3):143–8.
Mihata T, Quigley R, Robicheaux G, McGarry MH, Neo M, Lee TQ. Biomechanical characteristics of osteochondral defects of the humeral capitellum. Am J Sports Med. 2013;41(8):1909–14.
Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes. J Pediatr Orthop. 2010;30(1):8–13.
Smith MV, Bedi A, Chen NC. Surgical treatment for osteochondritis dissecans of the capitellum. Sports Health. 2012;4(5):425–32.
Takahara M, Ogino T, Sasaki I, Kato H, Minami A, Kaneda K. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res. 1999;363:108–15.
Shi LL, Bae DS, Kocher MS, Micheli LJ, Waters PM. Contained versus uncontained lesions in juvenile elbow osteochondritis dissecans. J Pediatr Orthop. 2012;32(3):221–5.
Kosaka M, Nakase J, Takahashi R, Toratani T, Ohashi Y, Kitaoka K, et al. Outcomes and failure factors in surgical treatment for osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2013;33(7):719–24.
Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001;83-A(1):25–34.
Bauer M, Jonsson K, Josefsson PO, Linden B. Osteochondritis dissecans of the elbow. A long-term follow-up study. Clin Orthop Relat Res. 1992;284:156–60.
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Kowalsky, M.S. (2015). Minimally Invasive Treatment of Elbow Articular Cartilage Injury. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15206-6_29-1
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DOI: https://doi.org/10.1007/978-3-319-15206-6_29-1
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