Abstract
We herein report two unusual cases of osteochondritis dissecans (OCD) of the trochlea. The injury consisted of a focal alteration of subchondral bone secondary to repetitive micro trauma from overhead maneuvers (pitching) in two male adolescents. Only 23 other cases of OCD affecting the trochlea have been reported. We comment on this discrepancy, explore the radiographic features, and detail the non-operative management that was undertaken. We substantiate our report with a systematic review of all OCD cases of the trochlea and provide information on patient demographics, sport type, management, recuperation and finally significance of radiographic grading.
Highlights
Osteochondritis dissecans (OCD)is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis [1,2].Originally, inflammation was implicated as the underlying etiology as reflected in the nomenclature; but currently two theories prevail: repetitive microtrauma and disruption of local vasculature with subsequent avascular necrosis [1, 3]
We substantiate our report with a systematic review of all osteochondritis dissecans (OCD) cases of the trochlea and provide information on patient demographics, sport type, management, recuperation and significance of radiographic grading
We subclassified the filtered articles based on study type: we report on 7 case report and 2 case series
Summary
Is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis [1,2]. The pediatric population is at a higher risk due to immature bone being more susceptible to similar stressors versus mature adult bone [15] To better document this rare condition, we report two cases of OCD at our own institution and performed a review of literature for all reported cases of OCD in the trochlea of the humerus, which has not been done since 2009 by Namba et al [13]. Pitching and athletic activities were discontinued for two months and the patient was provided a throwing program afterwards He returned to clinic sixteen months later due to gradual onset of pain and intermittent loss of velocity when throwing. Repeat radiographs (Figure 7) and MRI (Figure 8) studies demonstrated an OCD lesion along the lateral margin of the trochlea, with overlying articular cartilage injury, underlying subchondral sclerosis, and subtle bone marrow edema pattern, measuring approximately 0.7 cm x 0.8 cm on MRI. The patient has been asymptomatic since his last follow up visit, two years after his repeat presentation for pain
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