Panner's Disease Research Articles

Bone-cartilage transfer for osteochondritis dissecans of the humeral capitellum

Treatment of focal cartilage defects of the humeral capitellum with autologous bone-cartilage cylinders to prevent development of arthritis of the elbow joint. High-grade, unstable lesions (> 50% of the capitellum, gradeIII-IV according to Dipaola), including those involving the lateral edge of the capitellum and with adepth of up to 15 mm. Stable lesions and generalized osteochondritis of the capitellum (including Panner's disease), as well as arelative contraindication for lesions > 10 mm, as the largest punch has amaximum diameter of 10 mm. Arthroscopy of the elbow joint, transition to open surgery. First, the size of the cartilage defect in the capitellum is determined. Then, one (or several) osteochondral cylinders (OATS Arthex) are removed, which as far as possible completely encompass the defect zone. Corresponding intact bone-cartilage cylinders are obtained from the ipsilateral proximal lateral femoral condyle, each with a0.3 mm larger diameter via an additive miniarthrotomy. The "healthy" cylinders are then inserted into the defect zone in a"press fit" technique. An upper arm cast in neutral position of the hand for 10-14days, simultaneously beginning physiotherapy (active-assisted movements) and lymphatic drainage. As soon as painless range of motion (ROM) is restored (goal: by week6), isometric training can be started. Resistance training starts from week12. Competitive sports are only recommended after 6(-8) months. The current state of research on the surgical treatment of OCD of the humeral capitellum using autologous osteochondral grafts shows mostly promising results. Arecent meta-analysis of 24studies reports asignificantly higher (p < 0.01) rate of return to sports (94%) compared to fragment fixation (64%) or microfracture and debridement (71%) [41]. However, the increased donor-site morbidity must be taken into account (ca. 7.8%).

Incidence and Epidemiology of Symptomatic Capitellar Osteochondritis Dissecans of the Elbow: A United States Population-Based Study Over a 25-Year Period.

There are limited data on the incidence of capitellar osteochondritis dissecans (OCD) in the United States (US) population. To determine the incidence of symptomatic capitellar OCD in a representative US subpopulation and identify changes in its incidence over time and to investigate the relationship between the incidence of capitellar OCD and patient sex and age. Descriptive epidemiology study. A retrospective review was performed of patients aged ≤24 years from Olmsted County, Minnesota, with symptomatic capitellar OCD over a 25-year period (1995-2019). Patients with acute osteochondral injuries, Panner disease, and hereditary arthropathy were excluded. Poisson regression was utilized to identify the predictors of a capitellar OCD diagnosis. Incidence rates (per 100,000) were assessed for changes over time. Age groups of younger (10-15 years) versus older (16-24 years) patients were compared. A total of 45 patients (78% male) were identified. The mean age was 14.5 years (range, 10-24 years); 31 patients were in the younger group, and 14 patients were in the older group. Sport participation was seen in 89%of patients; 90% were overhead athletes, and 58% were throwing athletes. The incidence of capitellar OCD was 6.0 per 100,000 overall, 9.5 per 100,000 for male patients, and 2.6 per 100,000 for female patients. The incidence was highest for male patients in the younger group (15.3/100,000) and lowest for female patients in the older group (0.8/100,000). The estimated incidence rate ratio for younger versus older patients was 3.3 (P < .001), and the incidence rate ratio for male versus female patients was 3.5 (P < .001). There were no changes in the incidence of capitellar OCD over time as a continuous or 5-year categorical variable (P = .290 and P = .460, respectively). Overall, 82% of patients were treated surgically. There were no significant changes in surgical rates over time. In this US subpopulation, the overall incidence of symptomatic capitellar OCD between the ages of 10 and 24 years was 6.0 per 100,000 over the 25-year period studied, which is higher than previously reported US estimates. Incidence rates and treatment strategies did not change significantly over time.

Elbow Injuries in Children

Elbow Injuries in Children

Two cases of Panner's disease

Two cases of Panner's disease

History Page: Leaders in MSK Radiology Hans Jessen Panner, 1871-1930.

This history page in the series "Leaders in MSK Radiology" is dedicated to the memory and achievements of the Danish radiologist Hans Jessen Panner, whose name is connected to the medical eponym Panner's disease.

MRI of the Normal Elbow and Common Pathologic Conditions.

Anatomic and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret pathologic findings.

Think beyond tuberculosis: It can be Panner's disease in the child's elbow

Panner's disease also known as osteochondrosis of capitellum, is a rare disorder. We present a case of Panner's disease in an 11-year-old male child who was misdiagnosed as tuberculosis on clinical and radiological findings. The duration of symptoms was over 5 months, yet the child retained most of the elbow range of motion. He reported a sharp pain over the lateral condyle during end range of pronation and deep palpation. Plain radiograph findings were contour irregularities and flattening of the articular surface in humeral capitellum. Magnetic resonance imaging T2 images showed decreased signal intensity in capitellum as well as a high signal in joint space consistent with joint effusion. The joint aspirated clear synovial fluid with no culture growth. The outcome of Panner's disease was good with conservative treatment. Panner's disease is often misdiagnosed in our tubercular endemic regions and thus, awareness on the part of the clinician is must.

A case of Panner disease detected early and treated for shorter period

A case of Panner disease detected early and treated for shorter period

Two-year follow-up study of subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10 years.

To determine whether subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10years are indicative of early osteochondritis dissecans (OCD) of the capitellum. A total of 321 players aged 6-9years underwent ultrasonographic examination, and the findings for the subchondral bone of the capitellum on the throwing side were graded as 0, 1a, 1b, 2, or 3. Subjects classified as grade 1a or 1b showed irregularities of the subchondral bone surface and were investigated radiographically for OCD. All players continued to throw and were re-examined by ultrasonography after 1 and 2years. At the first examination, 11/321 (3.4%) had irregularities at the subchondral surface of the capitellum [grade 1a in 7/321 (2.2%); grade 1b in 4/321 (1.2%)]. The seven players with grade 1a showed no evidence of OCD or Panner's disease on radiography and were reclassified as grade 0 at the 2-year follow-up. All four players with grade 1b were reclassified as grade 0 at follow-up 1 and 2years later. Subchondral bone surface irregularities of the capitellum on ultrasonography in children under the age of 10years may not be indicative of disease, but rather represent variation of ossification during normal development.

Elbow Injury - Baseball

HISTORY: A 13-year-old male baseball player presented with intermittent lateral and posterior right elbow pain that became constant over the last month of travel baseball. The pain worsened in the cocking stage of throwing, and he reported decreased elbow extension. There was no numbness, tingling or weakness in his right upper extremity. Pain was a 4/10 at rest and worse with activity. PHYSICAL EXAMINATION: Slight right elbow effusion with tenderness over the olecranon and lateral and medial epicondyles. Range of motion was decreased to 15 degrees short of full extension. Range of motion did not elicit snapping of the triceps or ulnar nerve. There was pain with valgus stress of the right elbow but no instability. Strength of the upper extremity was normal with no pain elicited during strength testing. Tinel’s at the cubital tunnel was negative. DIFFERENTIAL DIAGNOSIS: 1. Osteochondritis Dissecans (OCD) of the capitellum 2. Panner’s Disease 3. Lateral/medial epicondylitis 4. Lateral/medial epicondyle apophysitis/avulsion fracture 5. Triceps tendinitis 6. Ulnar collateral ligament sprain 7. Olecranon stress fracture/loose body TEST AND RESULTS: Right elbow radiographs: -Small right elbow joint effusion Right elbow MRI: -Focal bone marrow signal changes in the anterior capitellum -Large joint effusion -Focal tiny subchondral fluid signal abnormality in mid capitellum -No visualized loose bodies -Suggestive of Panner disease or early OCD of the elbow Repeat right elbow MRI for increased pain after three weeks: -New 9 mm oval cartilaginous defect from the central capitellum, displaced in the medial joint recess posteriorly -No definite bony component -Underlying capitellar edema FINAL/WORKING DIAGNOSIS: -OCD of the capitellum TREATMENT AND OUTCOMES: 1. Right elbow arthroscopy with OCD drilling microfracture and loose body removal 2. Adjustable hinge elbow brace locked at 60–90 degrees of flexion for 2 weeks 3. Brace was loosened to 40–120 degrees after 2 weeks 4. Doing well at 5 week postoperative follow up. The brace was removed, and activities were restricted to no throwing activities for an additional 6 weeks. Then he was allowed slow return to throwing. 5. At one year follow up, he was doing well with no pain or symptoms. He was cleared for sports but instructed to refrain from pitching.

Shoulder and Elbow Injuries in the Adolescent Athlete.

With the recent increase in youth sports participation and single-sport youth athletes over the past 30 years, there has been an increase in the number of acute and overuse sports injuries in this population. This review focuses on overuse and traumatic injuries of the shoulder and elbow in young athletes. In particular we discuss little league shoulder, glenohumeral internal rotation deficit, glenohumeral instability, superior labrum anterior posterior lesions, Little League elbow, Panner disease, osteochondritis dissecans of the capitellum, posteromedial elbow impingement, and posterolateral rotatory instability of the elbow. There is a significant emphasis on the evaluation and management of upper extremity injury in the overhead thrower.

Panner's Disease Occurred in a Five-year-old Child: A Preliminary Case Report

Panner's Disease Occurred in a Five-year-old Child: A Preliminary Case Report

Panner's disease: literature review and treatment recommendations.

PurposeTo determine the most up-to-date theory on the aetiology of Panner’s disease, to form a consensus on the assessment of radiographs and to evaluate clinical outcome in order to summarise the best available evidence for diagnosis and treatment.MethodsA review of studies to date on Panner’s disease. Studies were eligible if: (1) the study provided criteria for defining Panner’s disease in order to eliminate confounding data on other radiographic entities that were mistakenly grouped and presented as Panner’s disease; (2) original data of at least one patient was presented; (3) manuscripts were written in English, German or Dutch; and (4) a full-text article was available. Animal studies, reviews and expert opinions were not included. Because the majority of the studies were case reports, we did not use an overall scoring system to evaluate methodological quality.ResultsTwenty-three articles reporting on Panner’s disease were included. Most cases of Panner’s disease were unilateral in distribution and occurred in boys during the first decade of life. In general, conservative treatment is advised for Panner’s disease. Panner’s disease is a self-limiting disease and the majority of patients heal without clinical impairment.ConclusionsBased on the results of this review, Panner’s disease should be treated conservatively. Uniform names and descriptions of signs on radiographs would help to make the correct diagnosis. Since Panner’s disease is very rare, higher quality studies are not likely to be performed and, thus, this review provides the best level of evidence on the current knowledge about Panner’s disease.

Common medial elbow injuries in the adolescent athlete

Recently there has been increased year-round sports participation among children and adolescents with limited to no rest periods. This has led to increases in pediatric repetitive stress injuries, once considered a rarity. Whether in the throwing athlete or in the athlete that experiences repetitive axial loading; increased medial tension and overload syndromes can lead to stress reactions and fractures. This occurs in the developing athlete due to the bone being weaker than the surrounding tendons and ligaments. The medial elbow is a high stress area and is susceptible to many conditions including apophysitis , avulsion fractures and ulnar collateral ligament disruption. Valgus stress can cause injury to the medial elbow which can lead to increased lateral compression, Panner's disease and osteochondral lesions of the capitellum and olecranon. The purpose of this manuscript is to review common elbow disorders in the adolescent population, outline management and highlight important features of rehabilitation.

Osteochondral Lesions of the Elbow

Osteochondral lesions of the elbow are injuries that disrupt the cartilage and subjacent bone, and they most commonly involve the capitellum. The staging, prognosis, and treatment of osteochondral lesions in the elbow are based on a combination of radiographic, magnetic resonance imaging, and arthroscopic findings. Radiographic staging includes the radiolucent, separation, and free (advanced) stages. MR imaging features of instability include cysts, osteochondral fracture, T2 hyperintense rim, subchondral plate defects, and fluid-filled osteochondral defects. Finally, arthroscopic grading of osteochondral lesions increases in severity based on findings of softened cartilage, cartilage fissuring, exposed bone, loose but nondisplaced fragments, and eventually displaced fragments resulting in intra-articular bodies. This pictorial review focuses on osteochondral lesions in the capitellum and trochlea including osteochondritis dissecans, Panner disease, and acute trauma.

A simple surgical technique for treatment of Freiberg's disease

BackgroundOf all the osteochondrosis, Freiberg's disease is reported to be the fourth most common, exceeded by Köhler's disease, Panner's disease, and Sever's disease. This disease usually occurs in the 2nd metatarsal head and relatively in the 3rd and 4th metatarsal heads. ObjectiveThe purpose of this study was to evaluate the outcome of debridement, synovectomy, dorsal closing wedge osteotomy and pin fixation for Freiberg's disease treatment. MethodsTen female patients, mean age 18.3 years; (ranged 14–24 years) were treated by the above mentioned technique. The main presenting symptom was pain on walking or sport; affected their daily life and activities and was not improved by non-surgical treatment. The second metatarsal head was affected in all patients. Halve of patients had a history of trauma. According to Smillie's classification, four patients were type V and six patients were type IV. Mean follow-up period was 19.2 months (range 6–36 months). ResultsWere assessed by the Lesser Metatarsophalangeal-Interphalangeal (LMPI)Scale by Kitaoka et al. At the final follow up, scoring was changed from (44–76) with an average 57 to (66–100) with an average 80. There was no case of infection, avascular necrosis, arthritis or pseudoarthrosis. ConclusionWe founded that dorsiflexion osteotomy of the metatarsal head is presented as a logical procedure that is simple, reliable, not destructive, and capable of good results regardless of the stage of the disease.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

Aseptická nekróza hlavičky humeru (Morbus Panner) řešena implantací solidního chondrograftu

Aseptická nekróza hlavičky humeru (Morbus Panner) řešena implantací solidního chondrograftu

Osteochondritis Dissecans in a Young Pitcher: Why Early Recognition Matters

Osteochondritis dissecans of the humeral capitellum is an unusual, but not rare, complication of repetitive stress to the skeletally immature elbow. This case report of a Little League player demonstrates how untreated underlying osteochondrosis resulted in permanent disability. Radiographs are essential. The differential diagnosis includes infection, cysts, and Panner's disease. For nondisplaced fragments, rest is indicated until pain resolves and range of motion returns; surgery or arthroscopy may be needed to remove or repair displaced fragments.

Osteochondritis Dissecans of the Capitellum: Current Concepts

Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. Unlike Panner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. The natural history of OCD is poorly understood, and degenerative joint disease may develop over time. Multiple modalities aid in diagnosis, including radiography, MRI, and magnetic resonance arthrography. Lesion size, location, and grade determine management, which should attempt to address subchondral bone loss and articular cartilage damage. Early, stable lesions are managed with rest. Surgery should be considered for unstable lesions. Most investigators advocate arthroscopic débridement with marrow stimulation. Fragment fixation and bone grafting also have provided good short-term results, but concerns persist regarding the healing potential of advanced lesions. Osteochondral autograft transplantation appears to be promising and should be reserved for larger, higher grade lesions. Clinical outcomes and return to sport are variable. Longer-term follow-up studies are necessary to fully assess surgical management, and patients must be counseled appropriately.