Arthroscopic debridement for osteochondral injury of the elbow trochlea: a case report with a long-term follow-up

Abstract

Q1 Osteochondral injury of the elbow is a rare lesion of the articular surface of the immature joint. A number of cases involving the humeral trochlea of adolescent throwing athletes have been reported in the English-language literature. 6 In the last decade, elbow arthroscopy has evolved to become an accepted technique for the treatment of elbow osteochondral lesions. 8 This is the first report in the literature of the use of arthroscopic debridement for the treatment of a rare osteochondral defect located to the humeral trochlea. Case report A right handedominant 15-year-old female athlete presented with complaints of left elbow pain and limited range of motion (ROM). There was no precedent history of elbow trauma. The patient was a competitive athlete in basketball and swimming. The initial examination by a local orthopaedic surgeon showed a minor elbow extension loss, and an initial diagnosis of triceps tendinitis was made. The diagnosis was based on normal elbow radiographs and a clinical finding of tenderness at the triceps insertion. The orthopaedic surgeon recommended rest and prescribed nonsteroidal anti-inflammatory drugs. However, during the course of the subsequent year, the patient remained active in sporting activities. Despite conservative measures, elbow pain and stiffness persisted, and the athlete was referred to our institution for further evaluation. According to her report, the duration of her symptoms was 1 year. Subsequent physical examination showed limited left elbow ROM from e35 ! of extension to 140 ! of flexion, with full forearm pronation and supination. There was no evidence of elbow swelling or instability. Plain radiographs of the left elbow were again normal (Fig. 1). However, magnetic resonance imaging (MRI) showed a high-signal focus on the posterior-superior surface of the humeral trochlea. The radiologic finding was consistent with an osteochondral lesion. Adjacent to the lesion, another high-signal focus indicated posterior synovial hypertrophy. The triceps tendon itself appeared normal (Fig. 2). On the basis of worsening symptoms, progressive loss of ROM, and MRI findings, a decision for surgical management was made. Q2