OUTCOMES OF SURGICAL TREATMENT OF OSTEOCHONDRAL LESIONS OF THE ELBOW IN PEDIATRIC AND ADOLESCENT ATHLETES

Abstract

BACKGROUND Osteochondral lesions of the elbow are a difficult entity to treat in high-demand individuals. Pediatric and adolescent patients who typically present with these lesions are upper extremity athletes involved in high demand sports. There has been relatively limited examination in the literature of these patients’ ability to return to sport at midterm follow-up; particularly after non-osteochondral grafting procedures such as fixation and micro-fracture. The purpose of this study was to determine the mid-term outcomes of lesion treatment in a cohort of pediatric and adolescent patients. METHODS This was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent surgical treatment for osteochondral lesions of the elbow. Patients were treated arthroscopically by a single surgeon from 2012 to 2017. All patients had confirmed osteochondral lesions of their elbow confirmed via MRI and underwent surgical intervention after failure of conservative treatment. Data including age, hand dominance, sporting activity, physeal status, imaging, intra-operative findings, procedure performed, post-operative complications, and return to sport were analyzed. RESULTS Twenty patients (twenty-two elbows) underwent surgical treatment with a mean age of 13.05 (±1.89) years with a mean follow-up 1.9 years. Fifteen males and 5 females were involved in the following sports: baseball (10), gymnastics (3), football (2), lacrosse (1), softball (2), and multi-sport (2). Sixty-three percent of the elbows had open physes at the time of surgical intervention. There were 19 capitellar lesions, 2 trochlear lesions, and 1 radial head lesion. The mean lesion size was 8.5 (±3.7) mm X 8.9 (±3.0) mm. Three patients underwent fixation, and the remainder underwent loose body removal and microfracture. No patients had any post-operative complications and all healed radiographically. One patient (4.5%) underwent a re operation due to repeat injury after gymnastics, and underwent an osteochondral autograft procedure. Thirty-percent of patients did not return to the same sport; forty-percent of baseball players and sixty-six percent of gymnasts. CONCLUSIONS / SIGNIFICANCE Osteochondral lesions of the elbow are a challenging entity to treat. Although arthroscopic intervention can be performed safely and result in radiographic healing, there is a high rate of inability to return to sport in patients involved in high impact upper extremity activity such as baseball and gymnastics with either fixation or lesion debridement /microfracture. Further treatment strategies in these patients including cartilage restoration procedures (i.e. OATS) may be warranted in this population.