Skip to main content
Erschienen in: Current Reviews in Musculoskeletal Medicine 2/2016

28.04.2016 | Elbow Soft Tissue Surgery (L Oh, Section Editor)

Osteochondritis dissecans of the elbow

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch, and a tenuous vascular supply of the capitellum. Recent literature reveals that the prevalence is likely higher than previously thought. This, in conjunction with increased levels of athletic competition in children at younger ages, has fed the recent interest in this topic. The literature continues to show that non-operative treatment is still successful for stable lesions. Unstable lesions, therefore, have been the focus of the new literature regarding operative management and outcomes. The aim of this paper is to provide a summary of current literature and an up-to-date approach to the diagnosis, evaluation, and treatment of osteochondritis dissecans of the capitellum.
Literatur
2.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
3.
4.
Zurück zum Zitat Jones KJ et al. Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes. J Pediatr Orthop. 2010;30(1):8–13.CrossRefPubMed Jones KJ et al. Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes. J Pediatr Orthop. 2010;30(1):8–13.CrossRefPubMed
5.
Zurück zum Zitat Shimada 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.CrossRefPubMedPubMedCentral Shimada 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.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Ahmad CS, Vitale MA, ElAttrache NS. Elbow arthroscopy: capitellar osteochondritis dissecans and radiocapitellar plica. Instr Course Lect. 2011;60:181–90.PubMed Ahmad CS, Vitale MA, ElAttrache NS. Elbow arthroscopy: capitellar osteochondritis dissecans and radiocapitellar plica. Instr Course Lect. 2011;60:181–90.PubMed
7.
Zurück zum Zitat Baker 3rd CL, Romeo AA, Baker Jr CL. Osteochondritis dissecans of the capitellum. Am J Sports Med. 2010;38(9):1917–28.CrossRefPubMed Baker 3rd CL, Romeo AA, Baker Jr CL. Osteochondritis dissecans of the capitellum. Am J Sports Med. 2010;38(9):1917–28.CrossRefPubMed
8.
Zurück zum Zitat Ahmad CSENS. Treatment of capitellar osteochondritis dissecans. Techniques in Shoulder and Elbow Surgery. 2006;7(4):169–74.CrossRef Ahmad CSENS. Treatment of capitellar osteochondritis dissecans. Techniques in Shoulder and Elbow Surgery. 2006;7(4):169–74.CrossRef
9.
Zurück zum Zitat Tis JE et al. Short-term results of arthroscopic treatment of osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop. 2012;32(3):226–31.CrossRefPubMed Tis JE et al. Short-term results of arthroscopic treatment of osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop. 2012;32(3):226–31.CrossRefPubMed
10.
Zurück zum Zitat Zlotolow DA, Bae DS. Osteochondral autograft transplantation in the elbow. J Hand Surg [Am]. 2014;39(2):368–72.CrossRef Zlotolow DA, Bae DS. Osteochondral autograft transplantation in the elbow. J Hand Surg [Am]. 2014;39(2):368–72.CrossRef
11.
Zurück zum Zitat Schub DL et al. Mapping of cartilage depth in the knee and elbow for use in osteochondral autograft procedures. Am J Sports Med. 2013;41(4):903–7.CrossRefPubMed Schub DL et al. Mapping of cartilage depth in the knee and elbow for use in osteochondral autograft procedures. Am J Sports Med. 2013;41(4):903–7.CrossRefPubMed
12.•
Zurück zum Zitat Claessen FM et al., Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography. J Shoulder Elbow Surg. 2015. Demonstrated that radiographic findings have poor to fair interobserver reliability and that MRI is needed for cases of osteochondritis dissecans of the capitellum. Claessen FM et al., Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography. J Shoulder Elbow Surg. 2015. Demonstrated that radiographic findings have poor to fair interobserver reliability and that MRI is needed for cases of osteochondritis dissecans of the capitellum.
13.
Zurück zum Zitat Lewine EB et al. Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2015. Lewine EB et al. Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2015.
14.•
Zurück zum Zitat Uchida S et al. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate acid thread pins for treating elbow osteochondritis dissecans. Am J Sports Med. 2015;43(5):1057–65. Demonstrated good results with return to play and pain relief with fragment fixation via an arthroscopic means avoiding an open arthrotomy of the elbow for fixation.CrossRefPubMed Uchida S et al. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate acid thread pins for treating elbow osteochondritis dissecans. Am J Sports Med. 2015;43(5):1057–65. Demonstrated good results with return to play and pain relief with fragment fixation via an arthroscopic means avoiding an open arthrotomy of the elbow for fixation.CrossRefPubMed
15.••
Zurück zum Zitat Maruyama M et al. 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. Demonstrated return to sport in a decreased time period from previous studies of patients undergoing OATS. Patients who return to sport returned at prior or improved level.CrossRefPubMed Maruyama M et al. 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. Demonstrated return to sport in a decreased time period from previous studies of patients undergoing OATS. Patients who return to sport returned at prior or improved level.CrossRefPubMed
16.••
Zurück zum Zitat Kida Y et al. Prevalence and clinical characteristics of osteochondritis dissecans of the humeral capitellum among adolescent baseball players. Am J Sports Med. 2014;42(8):1963–71. Found increased prevalence of OCD lesions amongst pitchers than previously reported. Found patients who had prior elbow pain and continued to pitch presented with more advanced lesions. Effectively used ultrasound as a screening tool.CrossRefPubMed Kida Y et al. Prevalence and clinical characteristics of osteochondritis dissecans of the humeral capitellum among adolescent baseball players. Am J Sports Med. 2014;42(8):1963–71. Found increased prevalence of OCD lesions amongst pitchers than previously reported. Found patients who had prior elbow pain and continued to pitch presented with more advanced lesions. Effectively used ultrasound as a screening tool.CrossRefPubMed
17.
Zurück zum Zitat Mihata T et al. Biomechanical characteristics of osteochondral defects of the humeral capitellum. Am J Sports Med. 2013;41(8):1909–14.CrossRefPubMed Mihata T et al. Biomechanical characteristics of osteochondral defects of the humeral capitellum. Am J Sports Med. 2013;41(8):1909–14.CrossRefPubMed
18.
Zurück zum Zitat Miyake J et al. In-vivo biomechanical analysis of osteochondritis dissecans of the humeral trochlea: a case report. J Pediatr Orthop B. 2013;22(4):392–6.CrossRefPubMed Miyake J et al. In-vivo biomechanical analysis of osteochondritis dissecans of the humeral trochlea: a case report. J Pediatr Orthop B. 2013;22(4):392–6.CrossRefPubMed
19.
Zurück zum Zitat Greiwe RM, Saifi C, Ahmad CS. Pediatric sports elbow injuries. Clin Sports Med. 2010;29(4):677–703.CrossRefPubMed Greiwe RM, Saifi C, Ahmad CS. Pediatric sports elbow injuries. Clin Sports Med. 2010;29(4):677–703.CrossRefPubMed
20.•
Zurück zum Zitat Lyons ML et al. Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes. J Shoulder Elbow Surg. 2015;24(7):1098–105. Showed good to excellent results in adolescent athletes with OATS procedures with return to play at previous level or higher in almost all patients.CrossRefPubMed Lyons ML et al. Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes. J Shoulder Elbow Surg. 2015;24(7):1098–105. Showed good to excellent results in adolescent athletes with OATS procedures with return to play at previous level or higher in almost all patients.CrossRefPubMed
21.
Zurück zum Zitat Hennrikus WP et al. Internal fixation of unstable in situ osteochondritis dissecans lesions of the capitellum. J Pediatr Orthop. 2015;35(5):467–73.CrossRefPubMed Hennrikus WP et al. Internal fixation of unstable in situ osteochondritis dissecans lesions of the capitellum. J Pediatr Orthop. 2015;35(5):467–73.CrossRefPubMed
22.
Zurück zum Zitat Kosaka M et al. Outcomes and failure factors in surgical treatment for osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2013;33(7):719–24.CrossRefPubMed Kosaka M et al. Outcomes and failure factors in surgical treatment for osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2013;33(7):719–24.CrossRefPubMed
23.
Zurück zum Zitat Iwasaki N et al. A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes. Am J Sports Med. 2012;40(3):624–30.CrossRefPubMed Iwasaki N et al. A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes. Am J Sports Med. 2012;40(3):624–30.CrossRefPubMed
24.
Zurück zum Zitat Dexel J et al. Comparative study of elbow disorders in young high-performance gymnasts. Int J Sports Med. 2014;35(11):960–5.CrossRefPubMed Dexel J et al. Comparative study of elbow disorders in young high-performance gymnasts. Int J Sports Med. 2014;35(11):960–5.CrossRefPubMed
25.
Zurück zum Zitat Zellner B, May MM. Elbow injuries in the young athlete—an orthopedic perspective. Pediatr Radiol. 2013;43 Suppl 1:S129–34.CrossRefPubMed Zellner B, May MM. Elbow injuries in the young athlete—an orthopedic perspective. Pediatr Radiol. 2013;43 Suppl 1:S129–34.CrossRefPubMed
26.
Zurück zum Zitat Schenck Jr RC et al. 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.CrossRefPubMed Schenck Jr RC et al. 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.CrossRefPubMed
27.
Zurück zum Zitat 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.PubMed 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.PubMed
28.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
29.
Zurück zum Zitat Zbojniewicz AM, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014;33(2):221–50.CrossRefPubMed Zbojniewicz AM, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014;33(2):221–50.CrossRefPubMed
30.
Zurück zum Zitat De Smet AA et al. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol. 1990;155(3):549–53.CrossRefPubMed De Smet AA et al. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol. 1990;155(3):549–53.CrossRefPubMed
31.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
32.
Zurück zum Zitat Jans LB et al. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol. 2012;81(6):1306–10.CrossRefPubMed Jans LB et al. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol. 2012;81(6):1306–10.CrossRefPubMed
33.
Zurück zum Zitat Satake H et al. Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum. Clin Orthop Relat Res. 2013;471(4):1137–43.CrossRefPubMed Satake H et al. Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum. Clin Orthop Relat Res. 2013;471(4):1137–43.CrossRefPubMed
34.
Zurück zum Zitat Harada M et al. Using sonography for the early detection of elbow injuries among young baseball players. AJR Am J Roentgenol. 2006;187(6):1436–41.CrossRefPubMed Harada M et al. Using sonography for the early detection of elbow injuries among young baseball players. AJR Am J Roentgenol. 2006;187(6):1436–41.CrossRefPubMed
35.
36.
Zurück zum Zitat Nofsinger C, Konin JG. Diagnostic ultrasound in sports medicine: current concepts and advances. Sports Med Arthrosc. 2009;17(1):25–30.CrossRefPubMed Nofsinger C, Konin JG. Diagnostic ultrasound in sports medicine: current concepts and advances. Sports Med Arthrosc. 2009;17(1):25–30.CrossRefPubMed
37.
Zurück zum Zitat Takahara M et al. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007;89(6):1205–14.CrossRefPubMed Takahara M et al. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007;89(6):1205–14.CrossRefPubMed
38.
Zurück zum Zitat Shi LL et al. Contained versus uncontained lesions in juvenile elbow osteochondritis dissecans. J Pediatr Orthop. 2012;32(3):221–5.CrossRefPubMed Shi LL et al. Contained versus uncontained lesions in juvenile elbow osteochondritis dissecans. J Pediatr Orthop. 2012;32(3):221–5.CrossRefPubMed
39.
Zurück zum Zitat Wulf CA et al. Magnetic resonance imaging after arthroscopic microfracture of capitellar osteochondritis dissecans. Am J Sports Med. 2012;40(11):2549–56.CrossRefPubMed Wulf CA et al. Magnetic resonance imaging after arthroscopic microfracture of capitellar osteochondritis dissecans. Am J Sports Med. 2012;40(11):2549–56.CrossRefPubMed
40.
Zurück zum Zitat Matsuura T et al. Conservative treatment for osteochondrosis of the humeral capitellum. Am J Sports Med. 2008;36(5):868–72.CrossRefPubMed Matsuura T et al. Conservative treatment for osteochondrosis of the humeral capitellum. Am J Sports Med. 2008;36(5):868–72.CrossRefPubMed
41.
Zurück zum Zitat Mihara K et al. Nonoperative treatment for osteochondritis dissecans of the capitellum. Am J Sports Med. 2009;37(2):298–304.CrossRefPubMed Mihara K et al. Nonoperative treatment for osteochondritis dissecans of the capitellum. Am J Sports Med. 2009;37(2):298–304.CrossRefPubMed
42.
Zurück zum Zitat Nishinaka N et al. Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum. J Shoulder Elbow Surg. 2014;23(12):1888–97.CrossRefPubMed Nishinaka N et al. Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum. J Shoulder Elbow Surg. 2014;23(12):1888–97.CrossRefPubMed
43.
Zurück zum Zitat 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.PubMed 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.PubMed
44.
Zurück zum Zitat Brownlow HC, O'Connor-Read LM, Perko M. Arthroscopic treatment of osteochondritis dissecans of the capitellum. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):198–202. Brownlow HC, O'Connor-Read LM, Perko M. Arthroscopic treatment of osteochondritis dissecans of the capitellum. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):198–202.
45.
Zurück zum Zitat 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.PubMed 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.PubMed
46.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
47.
Zurück zum Zitat Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy. 1998;14(8):797–803.CrossRefPubMed Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy. 1998;14(8):797–803.CrossRefPubMed
48.
Zurück zum Zitat Bojanic I, Smoljanovic T, Dokuzovic S. Osteochondritis dissecans of the elbow: excellent results in teenage athletes treated by arthroscopic debridement and microfracture. Croat Med J. 2012;53(1):40–7.CrossRefPubMedPubMedCentral Bojanic I, Smoljanovic T, Dokuzovic S. Osteochondritis dissecans of the elbow: excellent results in teenage athletes treated by arthroscopic debridement and microfracture. Croat Med J. 2012;53(1):40–7.CrossRefPubMedPubMedCentral
49.
Zurück zum Zitat Nishimura A et al. Functional recovery of the donor knee after autologous osteochondral transplantation for capitellar osteochondritis dissecans. Am J Sports Med. 2011;39(4):838–42.CrossRefPubMed Nishimura A et al. Functional recovery of the donor knee after autologous osteochondral transplantation for capitellar osteochondritis dissecans. Am J Sports Med. 2011;39(4):838–42.CrossRefPubMed
50.
Zurück zum Zitat Iwasaki N et al. Donor site evaluation after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint. Am J Sports Med. 2007;35(12):2096–100.CrossRefPubMed Iwasaki N et al. Donor site evaluation after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint. Am J Sports Med. 2007;35(12):2096–100.CrossRefPubMed
51.•
Zurück zum Zitat Gancarczyk SM et al., Arthroscopic articular reconstruction of capitellar osteochondral defects. Am J Sports Med, 2015. Showed via a cadaveric model that the vast majority of OCD lesions of the capitellum can be approached in an acceptable amount of perpendicularity via arthroscopic means. This may provide a future for lower morbidity surgery through arthroscopic methods for performing an OATS procedure. Gancarczyk SM et al., Arthroscopic articular reconstruction of capitellar osteochondral defects. Am J Sports Med, 2015. Showed via a cadaveric model that the vast majority of OCD lesions of the capitellum can be approached in an acceptable amount of perpendicularity via arthroscopic means. This may provide a future for lower morbidity surgery through arthroscopic methods for performing an OATS procedure.
Metadaten
Titel
Osteochondritis dissecans of the elbow
Publikationsdatum
28.04.2016
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 2/2016
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-016-9342-y

Weitere Artikel der Ausgabe 2/2016

Current Reviews in Musculoskeletal Medicine 2/2016 Zur Ausgabe

Elbow Soft Tissue Surgery (L Oh, Section Editor)

Elbow rheumatoid elbow: surgical treatment options

Elbow Soft Tissue Surgery (L Oh, Section Editor)

Treatment of complex elbow fracture-dislocations

ELBOW SOFT TISSUE SURGERY (L OH, SECTION EDITOR)

Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete

ACL Update: Objective Measures on Knee Instability (V Musahl, Section Editor)

Objective measurements of static anterior and rotational knee laxity

ACL Update: Objective Measures on Knee Instability (V Musahl, Section Editor)

Knee instability scores for ACL reconstruction

Elbow Soft Tissue Surgery (L Oh, Section Editor)

Ulnar neuropathy: evaluation and management

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.