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Technique for Arthroscopic Debridement and Microfracture of Unstable, Contained Osteochondritis Dissecans Lesions of the Capitellum.

ABSTRACT: Osteochondritis dissecans of the capitellum is an overuse injury that occurs primarily in adolescent athletes that causes pain and motion loss and can lead to chronic dysfunction. When diagnosed in its early stages, most lesions can be treated conservatively and without long-term consequences. Many osteochondritis dissecans lesions, however, continue to cause progressive symptoms despite nonoperative measures or are too advanced at the time of initial clinical presentation to be effectively treated without surgical intervention. The authors describe a safe and reproducible technique for the arthroscopic treatment of unstable, contained capitellar lesions.

SUBMITTER: DelBello SM

PROVIDER: S-EPMC7189419 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar osteochondritis dissecans (OCD).MethodsA comprehensive literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies were included if they evaluated OCD of the capitellum that underwent either arthroscopic debridement (AD) or MFX. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) scale. Patient demographic characteristics, imaging findings, return-to-sport rates, patient-reported outcomes, range of motion (ROM), complications, failures, and reoperations were recorded.ResultsEleven studies with 327 patients (332 elbows) met the inclusion criteria. Methodological Index for Non-randomized Studies (MINORS) scores ranged from 63% to 75% and showed considerable heterogeneity. Both AD and MFX showed improvement in patient outcome scores, ROM, and return to play, although the data precluded relative conclusions. Improvement in motion after MFX ranged from 4.9° to 5° of flexion, 5° to 22.6° of extension, 1° to 2° of pronation, and 0.5° to 2° of supination, whereas after AD, it ranged from -4° to 6° of flexion and -0.4° to 14° of extension, with prono-supination noted in only 1 study. The rate of return to play at a similar level of preinjury athletic competition ranged from 55% to 75% after MFX and from 40% to 100% after AD. Lesion location was discussed in only 1 study. Postoperative imaging trended toward early degenerative changes, most commonly of the radial head. Complications were only reported in 1 MFX study; in all cases, the complication was transient ulnar nerve neurapraxia. Reoperation rates ranged from 0% to 10%, and reoperation was most commonly performed to address radial head enlargement. Five studies reported no reoperations.ConclusionsBoth AD and MFX for capitellar OCD appear to yield excellent improvements in pain, ROM, patient outcome scores, and return to sport. Given that comparable mid-term outcomes can be achieved with debridement alone, without the use of MFX, similarly to recent prospective studies in the knee, AD alone may be a reasonable approach to relatively small OCD defects.Level of evidenceLevel IV, systematic review of studies, all Level IV evidence.

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Technique for Arthroscopic Debridement and Microfracture of Unstable, Contained Osteochondritis Dissecans Lesions of the Capitellum.

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