Nonoperative management of stable pediatric osteochondritis dissecans of the capitellum: predictors of treatment success

Abstract

Osteochondritis dissecans (OCD) of the capitellum is a rare but potentially debilitating condition. We sought to determine the healing potential of stable capitellar OCD treated nonoperatively, as well as factors predictive of successful nonoperative management. We performed a retrospective review of patients younger than 19 years who presented with stable OCD of the capitellum and were treated nonoperatively for a minimum of 2 months. The average clinical and radiographic follow-up period was 12.1 months (range, 3.1-63.7 months). A multivariable logistic regression model was used to determine independent predictors of healing. The study included 89 patients (93 elbows), including 49 male patients (55%); the mean age was 12.7 years (range, 8.9-18.6 years). Of the 93 elbows, 50 (53.8%) had successfully healed at a mean of 8.3 months. The symptom duration was significantly shorter in the healing group than the nonhealing group (5.3 ± 4.4 months vs 8.8 ± 9.0 months, P = .02). There were no significant differences in age, physeal status, sex, hand dominance, or sport. Hefti stage I lesions had a higher rate of healing (64.3%) than stage II (31.4%, P = .004), as did OCDs without cyst-like lesions (CLLs, 62.0%) compared with those with CLLs (20.8%, P = .001). The normalized lesion area was significantly larger in the nonhealing group (26.9% vs 18.6%, P < .001). A smaller normalized area and the absence of CLLs were independent predictors of healing. Over half of stable capitellar OCD lesions have the potential to heal with activity restriction. Smaller lesions without CLLs are more likely to heal with nonoperative treatment.