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Am J Sports Med 1998 Jul-Aug;26(4):520-3
Piedmont Orthopaedic, Greenville, South Carolina, USA.
This study was done to determine the results of the arthroscopic treatment of osteochondritis dissecans of the capitellum in a young population. A retrospective review of 16 patients (17 elbows) was performed by follow-up examination and radiographs. The average follow-up was 48 months, with a minimum of 24 months. All patients underwent abrasion chondroplasty of the lesion and removal of any loose bodies and osteophytes when present. Postoperatively, the average flexion contracture decreased by 14 degrees, and the average extension contracture decreased by 6 degrees. Two of nine patients gave up participation in throwing sports, and one of five gave up gymnastics. All others returned to their preoperative levels of activity. Radiographs showed some slight residual flattening of the capitellum in eight patients. Two patients required reoperation: one for arthrofibrosis and one for a suspected loose body. The results of this study suggest that arthroscopic abrasion chondroplasty and treatment of any accompanying pathologic lesions in the affected elbow gave good results in most patients. This is a short-term study in a young population. Further follow-up will be needed to determine any long-term problems with this type of treatment. An arthroscopic classification system has also been proposed.
Clin Orthop 1997 May;(338):36-41
Department of Orthopaedics and Rehabilitation Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Osteochondritis dissecans of the capitellum produces an area of focal necrosis that may result in a potentially unstable relationship between the capitellum and the radial head. Seven patients with developmental instability of the radial head secondary to osteochondritis dissecans of the capitellum treated between 1984 and 1995 were studied. All patients were male with an average age of 13 years. The most common symptom was pain with a decrease in range of motion. Patients lacked an average of 24.3 degrees extension. Initial plain radiographs were most helpful for evaluating the relationship of the radial head to the capitellum, and tomography or magnetic resonance imaging were helpful for the detection of loose bodies. The most common direction for instability was posterolateral. Treatment varied from conservative management with nonsteroidal antiinflammatory medication to open reduction and internal fixation of an osteochondral fragment. The average followup was 3.2 years. At latest followup, 11 patients were pain free; however, they lacked an average of 17 degrees extension. Only 2 patients progressed to complete dislocation of the radial head. Developmental instability of the radial head may occur secondary to osteochondritis dissecans of the capitellum. Plain radiographs are sufficient for initial detection and followup. Treatment is determined by the presence of loose bodies and the characteristics of the osteochondral defect. Initial symptoms will resolve; however, lack of extension may persist.
Z Orthop Ihre Grenzgeb 1996 Jan-Feb;134(1):73-5
Orthopadische Abteilung der Universitats-Kliniken Freiburg.
Osteochondritis dissecans is most frequently seen at the knee, the elbow and the ankle joint. The localisation at the humeral head is very rare. There were 7 cases like this reported up to now. We present two more patients with osteochondritis dissecans of the humeral head; a 26-year-old man and a 36-year-old woman. For diagnosis and follow-up roentgenograms and MRI are used. MRI even helps to decide which operative strategy should be followed. Drilling of the sclerotic margin resulted in a satisfactory bony reintegration of the fragment in our male patient. The female patient refused an arthroscopy of her shoulder joint.
AJR Am J Roentgenol 1995 May;164(5):1205-11
Overuse syndromes and injuries involving the elbow: MR imaging findings.
AJR Am J Roentgenol 1995 May;164(5):1205-11
Department of Radiology, University of Washington School of Medicine, Seattle 98195, USA.
Most elbow injuries result not from acute trauma but from repetitive microtrauma and chronic stress overload of the joint. Such "overuse" injuries may be difficult to diagnose clinically. Occasionally, even acute traumatic injuries may be occult radiographically and difficult to detect. In patients with elbow pain of uncertain origin, MR imaging may improve diagnostic specificity and accuracy. In this essay, characteristic MR imaging findings in common traumatic and overuse syndromes of the elbow are illustrated.
Clin Radiol 1994 Apr;49(4):231-5
Department of Radiology, Royal Orthopaedic Hospital, Birmingham.
Eleven cases of osteochondritis dissecans of the elbow are reviewed. Computed tomography (CT) accurately identified the abnormality, its extent and its precise location. Computed tomographic arthrography (CTA) allowed accurate delineation of the overlying cartilage in all cases, identifying cartilage defects in four patients, fissuring in two and cartilage thinning in a further two. In those patients who had plain CT, four were shown to have loose bodies, one of which was obscured by contrast medium at subsequent CTA. Two further patients with loose bodies were identified using CTA alone. The possible relevance of these findings to management is discussed.
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