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M. Panner und Osteochondrosis dissecans

Was wie behandeln?

M. Panner and osteochondrosis dissecans

What and how to treat?

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Zusammenfassung

Die Ätiopathogenese der osteochondralen Läsion des Capitulum humeri ist bis heute nicht abschließend geklärt. Abzugrenzen von der osteochondralen Läsion ist der M. Panner, einer juvenile Osteonekrose des gesamten Kapitulums.

Betroffene beider Erkrankungen beklagen belastungsabhängige Ellenbogenschmerzen im Sport und Bewegungseinschränkungen.

Die Diagnose kann zumeist anhand klinischer Untersuchung und Standardröntgenaufnahmen gestellt werden, sollte jedoch durch eine Magnetresonanztomographie (MRT) ergänzt werden.

Patienten mit stabilen osteochondralen Läsionen und offenen Wachstumsfugen werden konservativ behandelt, während instabile Läsionen operativ versorgt werden müssen.

Die konservative Therapie beinhaltet im Wesentlichen eine Belastungsmodifikation zur Entlastung des betroffenen Defekts und zeigt vor Wachstumsabschluss gute Ergebnisse.

Die Therapie des M. Panner entspricht der konservativen Therapie der osteochondralen Läsion und hat eine sehr gute Langzeitprognose.

Die operativen Behandlungsoptionen bei osteochondralen Läsionen des Ellenbogens sind zahlreich. Anwendung findet vor allem das arthroskopische Débridement, die Fragmentrefixierung sowie der osteochondrale Transfer.

Abstract

The etiopathogenesis of osteochondral defects of the capitulum is still not fully understood. Osteochondral lesions must be differentiated from Panner’s disease, a juvenile osteonecrosis of the entire capitellum.

Patients of either entity complain of stress-related pain during sports and movement restrictions of the joint.

The diagnosis can be made by clinical examination and X-ray standard examinations, but should be supplemented by MRI.

Stable lesions and patients with open growth plates are treated conservatively while instable lesions should be managed surgically.

Conservative treatment mainly involves activity modification and cessation of sports participation and shows good results particularly in patients with open capitellar physes.

Treatment of Pannerʼs disease is similar to the conservative treatment of osteochondral lesions and has a very good long-term prognosis.

The surgical treatment options for osteochondral lesions of the elbow are numerous and include primarily arthroscopic debridement, fragment fixation and osteochondral transplantation.

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Literatur

  1. Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB (2007) Chondral transplantation to treat osteochondral lesions in the elbow. J Bone Jt Surg 89:2188–2194

    Article  Google Scholar 

  2. Bauer M, Jonsson K, Josefsson PO, Lindén B (1992) Osteochondritis dissecans of the elbow. A long-term follow-up study. Clin Orthop Relat Res 156–160

  3. Bradley JP, Petrie RS (2001) Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sport Med 20:565–590

    Article  CAS  Google Scholar 

  4. Brownlow HC, OʼConnor-Read LM, Perko M (2006) Arthroscopic treatment of osteochondritis dissecans of the capitellum. Knee Surg Sports Traumatol Arthrosc 14:198–202

    Article  PubMed  Google Scholar 

  5. DiPaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104

    Article  PubMed  CAS  Google Scholar 

  6. Duthie RB, Houghton GR (1981) Constitutional aspects of the osteochondroses. Clin Orthop Relat Res 19–27

  7. Edmonds EW, Polousky J (2012) A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group. Clin Orthop Relat Res Feb 24. [Epub ahead of print]

  8. Klingele KE, Kocher MS (2002) Little league elbow: valgus overload injury in the paediatric athlete. Sports Med 32:1005–1015

    Article  PubMed  Google Scholar 

  9. Kobayashi K, Burton KJ, Rodner C, Smith B, Caputo AE (2004) Lateral compression injuries in the pediatric elbow: panner’s disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 12:246–254

    PubMed  Google Scholar 

  10. König F (1888) Über freie Körper in den Gelenken. Dtsch Z Chir

  11. Kusumi T, Ishibashi Y, Tsuda E, Kusumi A, Tanaka M, Sato F, Toh S, Kijima H (2006) Osteochondritis dissecans of the elbow: histopathological assessment of the articular cartilage and subchondral bone with emphasis on their damage and repair. Pathol Int 56:604–612

    Article  PubMed  Google Scholar 

  12. Laurent LE, Lindstrom BL (1956) Osteochondrosis of the capitulum humeri: Pannerʼs disease. Acta Orthop Scand 26:111–119

    PubMed  CAS  Google Scholar 

  13. Mihara K, Tsutsui H, Nishinaka N, Yamaguchi K (2009) Nonoperative treatment for osteochondritis dissecans of the capitellum. Am J Sports Med 37:298–304

    Article  PubMed  Google Scholar 

  14. Mihara K, Suzuki K, Makiuchi D, Nishinaka N, Yamaguchi K, Tsutsui H (2010) Surgical treatment for osteochondritis dissecans of the humeral capitellum. J Shoulder Elbow Surg 19:31–37

    Article  PubMed  Google Scholar 

  15. Mitsunaga MM, Adishian DA, Bianco AJ (1982) Osteochondritis dissecans of the capitellum. J Trauma 22: 53–55

    Article  PubMed  CAS  Google Scholar 

  16. Nelson DW, DiPaola J, Colville M, Schmidgall J (1990) Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 14:804–808

    Article  PubMed  CAS  Google Scholar 

  17. Panner H(1972) An affection of the capitulum humeri resembling Calvé-Perthesʼ Disease of the hip. Acta Radiol 10:234–242

    Google Scholar 

  18. Rahusen FTG, Brinkman J-M, Eygendaal D (2006) Results of arthroscopic debridement for osteochondritis dissecans of the elbow. Br J Sports Med 40:966–969

    Article  PubMed  Google Scholar 

  19. Ruch DS, Cory JW, Poehling GG (1998) The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy 14:797–803

    Article  PubMed  CAS  Google Scholar 

  20. Ruchelsman DE, Hall MP, Youm T (2010) Osteochondritis dissecans of the capitellum: current concepts. J Am Acad Orthop Surg 18:557–567

    PubMed  Google Scholar 

  21. Schenck RC, Athanasiou KA, Constantinides G, Gomez E (1994) A biomechanical analysis of articular cartilage of the human elbow and a potential relationship to osteochondritis dissecans. Clin Orthop Relat Res 299:305–312

    Google Scholar 

  22. Schoch B, Wolf BR (2010) Osteochondritis dissecans of the capitellum: minimum 1-year follow-up after arthroscopic debridement. Arthroscopy 26:1469–1473

    Article  PubMed  Google Scholar 

  23. Shimada K, Yoshida T, Nakata K, Hamada M, Akita S (2005) Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow. Clin Orthop Relat Res 435:140–147

    Google Scholar 

  24. Smith MG (1964) Osteochrondritis of the humeral capitulum. J Bone Joint Surg Br 46:50–54

    PubMed  CAS  Google Scholar 

  25. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K (1999) Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Am J Sports Med 27:728–732

    PubMed  CAS  Google Scholar 

  26. Takahara M, Mura N, Sasaki J, Harada M, Ogino T (2007) Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am 89:1205–1214

    Article  PubMed  Google Scholar 

  27. Takeda H, Watarai K, Matsushita T, Saito T, Terashima Y (2002) A surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum in adolescent baseball players. Am J Sports Med 30:713–717

    PubMed  Google Scholar 

  28. Vogt S, Siebenlist S, Hensler D, Weigelt L, Ansah P, Woertler K, Imhoff AB (2011) Osteochondral transplantation in the elbow leads to good clinical and radiologic long-term results: an 8- to 14-year follow-up examination. Am J Sports Med 39:2619–2625

    Article  PubMed  Google Scholar 

  29. Yadao MA, Field LD, Savoie FH (2004) Osteochondritis dissecans of the elbow. Instr Course Lect 53:599–606

    PubMed  Google Scholar 

  30. Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S (2006) Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up. Am J Sports Med 34:714–720

    Article  PubMed  Google Scholar 

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  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar (TUM), Ismaninger Str. 22,, 81675, München, Deutschland

    J.E. Plath, A. Lenich, A.B. Imhoff & S. Vogt

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  1. J.E. Plath
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  2. A. Lenich
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  3. A.B. Imhoff
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  4. S. Vogt
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Correspondence to J.E. Plath.

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Plath, J., Lenich, A., Imhoff, A. et al. M. Panner und Osteochondrosis dissecans. Obere Extremität 8, 16–21 (2013). https://doi.org/10.1007/s11678-013-0203-7

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