Arthroscopic procedures for osteochondritis dissecans of the humeral capitellum in adolescents and young adults: clinical outcomes with a mean follow-up of 2.5 years

Volume 3, Issue 3, June 2018     |     PP. 45-56      |     PDF (555 K)    |     Pub. Date: September 25, 2018
DOI:    1606 Downloads     7640 Views  

Author(s)

Yingchun Zhu, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Xuewen Jia, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Zhanping Jin, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Yunfeng Mi, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Zheyang Wang, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Yufeng Zhu, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Chunxiao Gu, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Jihong Zhang, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Cui Wang, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China
Dongdong Xia, Department of Orthopaedic Surgery, Ningbo First Hospital, No. 59, LiuTing Street, Ningbo, Zhejiang, 315010, China

Abstract
Objective. To evaluate functional outcomes and complications in a consecutive group of patients with elbow osteochondritis dissecans(OCD) treated with arthroscopic procedure. Methods. Twenty-seven patients who had undergone arthroscopic procedure for elbow osteochondritis dissecans (OCD) were recruited from May 2013 to July 2016.There were twenty males and seven females, aging from 15 to 35 years old. All of the twenty-seven patients had complained of pain and fifteen patients had mechanical symptoms, such as catching and locking. The patients positioned lateral decubitus under general anesthesia, proximal anterolateral, proximal anteromedial, midlateral(soft spot), straight posterior and posterolateral portals were used to explore and debride elbow joint, remove loose bodies and take microfracture procedures. Clinical assessment consist of elbow ROM, the Mayo Elbow Performance Score(MEPS). Postoperative complications were also assessed. Results. All patients achieved primary healing. twenty-seven patients were followed up for 11 to 48 months (mean 34months). twenty-four elbows (88.9%) had no pain or only mild pain and three patients (11.2%) had moderate pain at the last follow-up. Mechanical symptoms had disappeared in all fifteen patients. The flexion and extension ROM and the Mayo Elbow Performance Score(MEPS) had improved significantly（P<.05）at the last follow-up, According to the Mayo Elbow Performance Score(MEPS), the result was excellent in twenty-one elbows, good in three elbows. The complications: transient injury of ulnar nerve in one patient. Conclusion.In mid-term follow-up, arthroscopy is a reliable procedure for the elbow osteochondritis dissecans(OCD) that produce significant clinical functional improvements and without severe complications.

Keywords
Osteochondritis dissecans, Elbow joint, Arthroscopy, Debridement, microfracture

Cite this paper
Yingchun Zhu, Xuewen Jia, Zhanping Jin, Yunfeng Mi, Zheyang Wang, Yufeng Zhu, Chunxiao Gu, Jihong Zhang, Cui Wang, Dongdong Xia, Arthroscopic procedures for osteochondritis dissecans of the humeral capitellum in adolescents and young adults: clinical outcomes with a mean follow-up of 2.5 years , SCIREA Journal of Clinical Medicine. Volume 3, Issue 3, June 2018 | PP. 45-56.

References

[ 1 ] Matsuura T, Kashiwaguchi S, Iwase T, et al. Conservative treatment for osteochondrosis of the humeral capitellum[J]. Am J Sports Med, 2008, 36(5):868-872.
[ 2 ] Takahara M, Mura N, Sasaki J, et al. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum[J]. J Bone Joint Surg (Am). 2007, 89(6):1205-14.
[ 3 ] Ruchelsman DE, Hall MP, Youm T. Osteochondritis dissecans of the capitellum: current concepts[J]. J Am Acad Orthop Surg. 2010, 18(9): 557-567. 

[ 4 ] Schenck RC, Goodnight JM. Osteochondritis dissecans[J]. J Bone Joint Surg (Am). 1996, 78(3):439-456.

[ 5 ] Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers[J]. Med Sci Sports Exerc. 2001,33(11):1803-1810.
[ 6 ] Yamaguchi K, Sweet FA, Bindra R, et al. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg (Am). 1997,79(11):1653-1662.
[ 7 ] Kelle EW, Bryce R, Coqhlan J, et al. Arthroscopic debridement without radial head excision of the osteoarthritic elbow[J]. Arthroscopy, 2007, 23(2):151-156.
[ 8 ] Schenck RC Jr, Athanasiou KA, Constantinides G, et al. A biomechanical analysis of articular cartilage of the human elbow and a 
potential relationship to osteochondritis dissecans[J]. Clin Orthop Relat Res. 1994,(299):305-312.

[ 9 ] Mihara K, Tsutsui H, Nishinaka N, et al. Nonoperative treatment for osteochondritis dissecans of the capitellum[J]. Am J Sports Med. 2009, 37(2):298-304.
[ 10 ] Takahara M, Shundo M, Kondo M, et al. Early detection of osteochondritis dissecans of the capitellum in young baseball players: report of three cases[J]. J Bone Joint Surg Am. 1998;80(6):892-897. 

[ 11 ] Oka Y, Ohta K, Fukuda H. Bone-peg grafting for osteochondritis dissecans of the elbow[J]. Int Orthop. 1999, 23(1):53-57.
[ 12 ] Lyons ML, Werner BC, Gluck JS, et al. Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes[J]. J Shoulder Elbow Surg. 2015, 24(7):1098-105.
[ 13 ] Uribe JW, Kessler KJ, Arthroscopic treatment of osteochondral lesion of the capitellum [J]. Orthopedic surgeons, 1994, 24(5):143-151.
[ 14 ] Paul B, Robert J. Goitz D. Elbow arthroscopy: Surgical techniques and rehabilitation [J]. J Hand Ther, 2006,13:228–236.
[ 15 ] Zeng C, Huang DM, Cai DZ et al. Anatomic relationship between portals and nearby nevers at different positions in elbow arthroscopy[J]. Chin J Orthop Trauma, 2008,10(12): 1141-1144. In Chinese.
[ 16 ] Ruchelsman DE, Hall MP, Youm T. Osteochondritis dissecans of the capitellum: current concepts[J]. J Am Acad Orthop Surg. 2010;18(9): 557-567.
[ 17 ] Klingele KE, Kocher MS. Little League elbow: valgus overload injury in the paediatric athlete [J]. Sports Med. 2002;32(15):1005-1015.
[ 18 ] Lewine EB, Miller PE, Micheli LJ, et al. Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum[J]. J Pediatr Orthop. 2016,36(8):803-809.
[ 19 ] Bojanic I, Ivkovic A, Boric I. Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts[J]. Knee Surg Sports Traumatol Arthrosc. 2006,14(5):491-496. 

[ 20 ] Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow[J]. Arthroscopy. 1998, 14(8):797-803.
[ 21 ] Westermann RW, Hancock KJ, Buckwalter JA, et al. Return to sport after operative management of osteochondritis dissecans of the capitellum: a systematic review and meta-analysis[J]. Orthop J Sports Med. 2016, 4(6):675-680.
[ 22 ] Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy[J]. J Bone Joint Surg (Am)，2001，83:25–34.
[ 23 ] David S. Ruch, Gary G. Poehling. Anterior interosseus nerve injury following elbow arthroscopy [J]. Arthroscopy, 1997,13(6):756-758.