Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm
Purpose of the Review
To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience.
Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. These studies have focused on understanding how lesion characteristics such as size, location, and appearance on advanced imaging can predict treatment success. Current literature continues to support nonoperative management for stable lesions. Operative intervention is generally required for unstable lesions and treatment strategies are largely dictated by lesion size and location: debridement or reparative techniques for small lesions while larger lesions or those in high-stress locations are better served by bone and/or cartilage restoration procedures. There has been a rising interest in the use of allograft materials and cell-based therapies.
Overhead athletes are uniquely predisposed to capitellar OCD due to the nature of forces applied to the radiocapitellar joint during repeated activity in the overhead position. Despite improvements in operative techniques, successful use of alternative graft materials, and a better understanding of how lesion characteristics influence results, there is still much to learn about this challenging disorder. Future research should focus on comparing operative techniques, refining their indications, and further developing a reliable treatment algorithm that best serves the overhead athlete.
KeywordsOsteochondritis dissecans (OCD) Humeral capitellum Overhead athlete Elbow pain Baseball players Gymnasts
Compliance with Ethical Standards
Conflict of Interest
Anthony L. Logli, Christopher D. Bernard, and Christopher L. Camp declare no conflict of interest.
Shawn W. O’Driscoll has received royalties from Acumed, LLC, Tornier, Inc., and Aircast.
Joaquin Sanchez-Sotelo is a board member of the American Academy of Orthopedic Surgeons, American Shoulder and Elbow Surgeons, the Journal of Orthopaedics and Traumatology, the Journal of Shoulder and Elbow Arthroplasty, and the Journal of Shoulder and Elbow Surgery. Dr. Sanchez-Sotelo has received publishing royalties from the Journal of Shoulder and Elbow Surgery and Oxford University Press; personal fees from Acumed, LLC, Elsevier, Exactech, and Wright Medical Technology; and a grant and personal fees from Stryker.
Mark E. Morrey has stock or stock options in Tenex.
Aaron J. Krych has received grants from Aesculap/B.Braun, Arthritis Foundation, Ceterix, and Histogenics; grants and personal fees from Arthrex, Inc.; and personal fees from JRF Ortho and Vericel. Dr. Krych is a board member for the American Journal of Sports Medicine, the International Cartilage Repair Society, the International Society for Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, the Minnesota Orthopedic Society, and the Musculoskeletal Transplantation Foundation.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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