Arthroscopic Debridement and Microfracture of Capitellar Osteochondritis Dissecans of the Elbow (SS-24)

Abstract

IntroductionOsteochondritis dissecans of the humeral capitellum is a condition seen with relatively high frequency in young baseball players and gymnasts. A variety of surgical procedures have been utilized to treat this challenging condition with variable success rates. The purpose of this study is to analyze the results of arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum.MethodsUtilizing the computerized database of an orthopaedic sports medicine practice, a retrospective chart-review was performed on a consecutive series of patients who underwent arthroscopic treatment for osteochondritis dissecans of the capitellum between January 1994 and August 2008. Patients were evaluated clinically by assessing range of motion, return to sport and Andrews-Carson elbow scores. Plain radiographs were also reviewed to evaluate for progressive degenerative changes.ResultsIn the fourteen-year period investigated, twenty-nine elbows in twenty-eight patients were identified that had undergone arthroscopic debridement and microfracture. All patients had unstable lesions based on clinical exam and magnetic resonance imaging or had failed an attempt at conservative treatment. At an average follow-up of twenty months after surgery, the mean range of motion was 4.5 to 136.4 degrees. The average Andrews-Carson score was 186.8 and eighteen of the twenty-eight patients (64%) returned to sport. Radiographic evidence of lesion progression was seen in only two of the twenty-nine (7%) elbows treated.ConclusionThese results show that arthroscopic debridement and microfracture can produce good to excellent outcomes in the majority of patients with osteochondritic lesions of the capitellum. There is a low incidence of progressive radiographic changes associated with this technique and the majority of patients are able to return to sport in the short-term. IntroductionOsteochondritis dissecans of the humeral capitellum is a condition seen with relatively high frequency in young baseball players and gymnasts. A variety of surgical procedures have been utilized to treat this challenging condition with variable success rates. The purpose of this study is to analyze the results of arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum. Osteochondritis dissecans of the humeral capitellum is a condition seen with relatively high frequency in young baseball players and gymnasts. A variety of surgical procedures have been utilized to treat this challenging condition with variable success rates. The purpose of this study is to analyze the results of arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum. MethodsUtilizing the computerized database of an orthopaedic sports medicine practice, a retrospective chart-review was performed on a consecutive series of patients who underwent arthroscopic treatment for osteochondritis dissecans of the capitellum between January 1994 and August 2008. Patients were evaluated clinically by assessing range of motion, return to sport and Andrews-Carson elbow scores. Plain radiographs were also reviewed to evaluate for progressive degenerative changes. Utilizing the computerized database of an orthopaedic sports medicine practice, a retrospective chart-review was performed on a consecutive series of patients who underwent arthroscopic treatment for osteochondritis dissecans of the capitellum between January 1994 and August 2008. Patients were evaluated clinically by assessing range of motion, return to sport and Andrews-Carson elbow scores. Plain radiographs were also reviewed to evaluate for progressive degenerative changes. ResultsIn the fourteen-year period investigated, twenty-nine elbows in twenty-eight patients were identified that had undergone arthroscopic debridement and microfracture. All patients had unstable lesions based on clinical exam and magnetic resonance imaging or had failed an attempt at conservative treatment. At an average follow-up of twenty months after surgery, the mean range of motion was 4.5 to 136.4 degrees. The average Andrews-Carson score was 186.8 and eighteen of the twenty-eight patients (64%) returned to sport. Radiographic evidence of lesion progression was seen in only two of the twenty-nine (7%) elbows treated. In the fourteen-year period investigated, twenty-nine elbows in twenty-eight patients were identified that had undergone arthroscopic debridement and microfracture. All patients had unstable lesions based on clinical exam and magnetic resonance imaging or had failed an attempt at conservative treatment. At an average follow-up of twenty months after surgery, the mean range of motion was 4.5 to 136.4 degrees. The average Andrews-Carson score was 186.8 and eighteen of the twenty-eight patients (64%) returned to sport. Radiographic evidence of lesion progression was seen in only two of the twenty-nine (7%) elbows treated. ConclusionThese results show that arthroscopic debridement and microfracture can produce good to excellent outcomes in the majority of patients with osteochondritic lesions of the capitellum. There is a low incidence of progressive radiographic changes associated with this technique and the majority of patients are able to return to sport in the short-term. These results show that arthroscopic debridement and microfracture can produce good to excellent outcomes in the majority of patients with osteochondritic lesions of the capitellum. There is a low incidence of progressive radiographic changes associated with this technique and the majority of patients are able to return to sport in the short-term.