Mid to Long Term Outcome after Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athlete

摘要

Objectives: Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes were often seen in baseball players and gymnasts, and surgeries are indicated for unstable lesions. From 2002 to 2010, we had performed arthroscopic (AS) fragment resection for all inviable lesions regardless of lesion size, though osteochondral grafting have been added for larger lesions since 2010. Several studies have reported short-term outcomes after AS resection for capitellar OCD in adolescent athletes; however, long-term outcomes have not been reported. The purpose of this retrospective study was to investigate functional outcomes and arthritic change in a mid to long-term postoperative period after AS resection for capitellar OCD with small to large lesions in adolescent athletes. Methods: Between 2002 and 2010, 77 elbows in 76 consecutive patients with skeletally immature elbows, which had open epiphyseal lines in the contralateral elbow, underwent AS resection for capitellar OCD. Forty-three elbows in 43 patients (38 males and 5 females with a mean age of 14 years (13-15) who were followed up for at least 5 years (average 8 years; 5-12) were included in this study. Thirty-two patients were engaged in baseball, 7 in gymnastics, and 4 in other sports. The size of OCD lesions was determined with preoperative radiographs. Elbows with a lesion which width did not exceed 1/2 of radial head diameter were assigned to group S (19 elbows), and elbows with a larger lesion to group L (24 elbows). Sports return, DASH score, patient satisfaction, and range of motion (ROM) were reviewed. Radiographs at final follow-up were obtained from 17 and 21 elbows in groups S and L, respectively, and pre- and postoperative osteoarthritis (OA) grade were evaluated. Mann-Whitney’s U test (for sports return and OA progression), paired t test (for pre- and postoperative ROM) and Welch’s T test (for satisfaction, DASH score, and ROM) were used for comparison between the two groups. Results: All patients returned to sports activity, and there was no significant difference in sports return rates between the groups with 17 (89%) and 21 (88%) full-return patients in groups S and L, respectively. DASH score at final follow-up had also no difference. Patient satisfaction (0 to 100 scale) was 91 (70-100) in Group S, and 78 (50-100) in Group L, and the difference was significant (p< 0.01). Flexion ROM at final follow-up did not show significant improvement in both groups compared to preoperative values: Group S, 135 (115-150) to 141 (125-150) degrees; group L, 131 (110-145) to 133 (120-145) degrees. There was a significant difference in flexion ROM at final follow-up between the groups (P=0.001). Extension ROM showed significant improvement in both groups: group S, -8 (-25-5) to 3 (-10-13) degrees (P<0.001); group L -17 (-50-0) to -1 (-15-20) degrees (P<0.001). Group S tended to have better extension than group L, but the differences was not significant (P=0.05). There were no severe OA elbows in both groups. OA change progressed in 2 elbows (12%) in Group S and 4 elbows (19%) in Group L, and the difference was not significant. Conclusion: Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with a small lesion. Although, in elbows with larger lesions, overall outcomes were acceptable, ROM and patient satisfaction were inferior to those with small lesions. AS resection can be an effective treatment for elbows with a small OCD lesion as well as for those with a large lesion.