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A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow.

Methods

The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score.

Results

Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10–18.5) and a median follow-up of 39 months (range 5–156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic–assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8–99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70–87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3–94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5–95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3–99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7–99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients).

Conclusion

Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures.

Level of evidence

Level IV.

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Abbreviations

OCD:

Osteochondritis dissecans

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

OATS:

Osteochondral autograft transplantation

MEPS:

Mayo elbow performance score

DASH:

Disabilities of the arm, shoulder and hand

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Dan Cohen, Jeffrey Kay, Muzammil Memon, David Slawaska-Eng, Nicole Simunovic & Olufemi R. Ayeni

Authors
  1. Dan Cohen
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  2. Jeffrey Kay
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  3. Muzammil Memon
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  4. David Slawaska-Eng
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  5. Nicole Simunovic
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  6. Olufemi R. Ayeni
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Contributions

DC participated in the design of the study, carried out the systematic review, extracted data, provided illustrations, and drafted the manuscript. JK carried out the systematic review, extracted data, completed the statistical analysis and revised the manuscript. Authors MM and DSE participated in the study design and participated in drafting and revising the manuscript. OA conceived of the study and participated in the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

The authors declare that they have no competing interests.

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This study does not contain any studies with human participants or animals performed by any of the authors.

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Appendix Table 1: Search strategy

Appendix Table 1: Search strategy

Medline: 1548 Studies

Embase: 2725 Studies

PubMed: 2031 Studies

Strategy

Studies

Strategy

Studies

Strategy

Studies

1. Osteochondritis Dissecans.mp. or Osteochondritis Dissecans/

2394

1. Osteochondritis Dissecans.mp. or Osteochondritis Dissecans/

3083

1. Osteochondritis Dissecans

2,509

2. Ocd.mp.

9747

2. Ocd.mp.

14,311

2. OCD

9,880

3. Sport.mp. or Sports/

56,145

3. Sport.mp. or Sports/

101,408

3. Sport

336,590

4. Return to sport/ or return.mp.

110,778

4. Return to Sport/ or return.mp.

154,089

4. Return

243,648

5. Play.mp.

684,089

5. Play.mp.

857,945

5. Play

687,583

6. Activit*.mp.

3,274,092

6. Activit*.mp.

4,510,279

6. Activit*

3,197,198

7. 1 or 2

11,588

7. 1 or 2

16,721

7. 1 or 2

11,833

8. 3 or 4 or 5 or 6

3,938,868

8. 3 or 4 or 5 or 6

5,347,517

8. 3 or 4 or 5 or 6

4,172,423

9. 7 and 8

1548

9. 7 and 8

2725

9. 7 and 8

2,031

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Cohen, D., Kay, J., Memon, M. et al. A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 29, 4041–4066 (2021). https://doi.org/10.1007/s00167-021-06489-9

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