Adolescent Osteochondritis Dissecans: Long-Term Outcomes After Non-Reconstructive Elbow Arthroscopy

Abstract

Osteochondritis Dissecans (OCD) is a condition of the cartilage/osteochondral interface. In the elbow, it occurs predominantly in the dominant arm of overhead adolescent athletes. Proposed pathophysiology is related to avascular necrosis of the subchondral bone and initial treatment is activity cessation/modification with a trial of NSAIDs. Among others, surgical options include non-reconstructive procedures like debridement, loose body removal or microfracture. Short to medium term outcomes data after such procedures demonstrate promising outcomes, however long-term data is scarce. We hypothesized that adolescent elbow OCD lesions treated with non-reconstructive arthroscopic means will have excellent long-term outcomes. This was a single-center retrospective analysis of patients under 18 years of age with elbow OCD who underwent non-reconstructive arthroscopic treatment between 2006 and 2016. Patients who underwent reconstructive procedures, had follow-up of less than four weeks, or had history of prior elbow surgery were excluded. Demographics, medical history, operative notes, and patient-reported outcomes (QuickDASH and Likert Pain Scale scores) were reviewed. Student t-test and chi-square analyses were performed to compare continuous and categorical variables, respectively, with significance set at p<0.05. Eighteen arthroscopies in 17 patients were included for analysis. Mean age at time of surgery was 14.1 ± 2.5 years. The 18 cases included; 11: arthroscopic debridement with loose body removal, 6: arthroscopic debridement alone, and 1: debridement with microfracture. At mean follow-up time of 8.2 ± 3.5 years (range 2.9 to 12.9 years), mean QuickDASH score was 6.9 ± 16.4 and Likert score was 0.9 ± 1.7. There were two failures of initial treatment; one repeat elbow arthroscopy for removal of loose bodies and another patient who reported severe limitation to his operative elbow, with intraoperative range of motion of 45-110 degrees and a QuickDASH score of 70.5 at 10-year follow-up. Adolescent elbow OCD lesions treated with non-reconstructive arthroscopic means have excellent long-term outcomes.