Long-Term Outcomes of Arthroscopic Debridement With or Without Drilling for Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players: A >= 10-Year Follow-Up Study

摘要

Purpose: To evaluate the long-term clinical outcomes of arthroscopic debridement for capitellar osteochondritis (OCD) in adolescent baseball players. Methods: This retrospective study evaluated clinical outcomes of debridement for capitellar OCD in adolescent baseball players seen between 2003 and 2006. Inclusion criteria were 10 years of follow-up after surgery. Exclusion criteria were previous elbow surgery and age 19 Patients were examined for presence of pain, inflammation (effusion), and range of motion. Outcome determined using Timmerman/Andrews scores. Defect severity on preoperative radiographs was classified into 3 grades: small, moderate, and large. Return to baseball, pre- and postoperative range of motion and Timmerman/Andrews elbow score were evaluated according to defect severity. Results: Twenty-three elbows of 23 baseball players (mean age, 14.7 [range, 13-17] years) underwent arthroscopic debridement for capitellar OCD. Mean follow-up duration was 11.5 (range, 10-13) years. Twenty patients (87%) returned to competitive baseball at their preoperative level; of these, 15 were non pitchers and returned to the same position but only 1 of 5 pitchers returned to playing pitcher. One patient with a large defect and drilling underwent reoperation 11 years after the initial operation. Mean change in extension was 4.3 and that in flexion was 3.7 degrees. Timmerman/Andrews score improved significantly from 160 (95% confidence interval 146.7-173.3) to 195 (95% confidence interval 185.2-204.8) at the most recent follow-up (P-<.0001). Osteochondral defects detected on preoperative radiographs were small in 10 patients, moderate in 7, and large in 6. There was no significant between-group difference in extension, flexion, or Timmerman/Andrews score preoperatively or at the most recent follow-up. Conclusions: Arthroscopic debridement with or without drilling allowed return to play in adolescent baseball players for positions other than pitchers. Long-term outcomes are likely durable regardless of lesion size. Level of evidence: Level IV, Case series.