osteochondritis dissecans capitellum

Epub 2008 Dec 4. Unfortunately, the ability to prognosticate when conservative treatment will be successful is not well established, and the decision whether to initiate nonoperative versus operative management in capitellar OCD focuses on the extent of disease, the time from onset of symptoms, and the patient’s expectations and desires. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. OCD of the humeral capitellum remains a difficult problem to treat. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. On the contrary, unstable lesions possess one of the following characteristics: a closed capitellar growth plate, lesion fragmentation, or restricted elbow motion ≥ 20 degrees. In the talus, 96% of lateral lesions and 62% of … Stage IV lesions are characterized by separation from the capitellum chondral surface by a high signal interface. CrossRef Google Scholar. Mihara K, Tsutsui H, Nishinaka N, Yamaguchi K. Am J Sports Med. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. In more severe cases, athletes may develop mechanical symptoms, such as catching, clicking, and locking, suggesting the presence of intraarticular loose bodies. The Research in Osteochondritis of the Knee (ROCK) study group has come to define OCD as “a focal, idiopathic alteration of subchondral bone with risk of instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis” ( ). Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. eCollection 2017 Dec. Osteochondritis dissecans of the humeral capitellum. Ultimately, repetitive stress of this nature leads to disruption of a localized portion of the subchondral bone and, if allowed to progress, the overlying articular cartilage. Osteochondritis dissecans (OCD) of the elbow is increasing in prevalence in American pediatric populations. Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. 2009 Feb;37(2):298-304. doi: 10.1177/0363546508324970. Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. Osteochondritis dissecans of the capitellum: lesion size and pattern analysis using quantitative 3-dimensional computed tomography and mapping technique. Crepitus at the elbow may be palpable with flexion and extension. Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. 0 . 2001 Jan;20(1):1-9. doi: 10.1016/s0278-5919(05)70243-x. Furthermore, patients’ lesions often heal their and patients return to full activities despite the lack of full radiographic healing. It is defined as a localized fragmentation of bone overlying the capitellum cartilage. Ultimately the decision on how to treat a particular lesion is determined both by the extent of the lesion and by the athlete’s desire to participate in the chosen sport. Osteochondritis dissecans (OCD) of the outer elbow side of the arm bone, or capitellum, is a condition that results from repetitive trauma to the capitellum. Classic radiography finding of capitellar OCD with radiolucency of the anterolateral capitellum. CLINICAL CASE PRESENTATION . A case report. A capitellar OCD prevalence study used ultrasound as the screening examination and found that it had a 100% positive predictive value. 4th ed. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Provoking compressive forces on the capitellum commonly occur in the dominant arm of overhead throwing athletes and from weight-bearing stress in gymnasts in the second decade of life. The radiocapitellar compression test is a useful physical examination maneuver for diagnosis.  |  The elbow should be examined for any evidence of effusion. Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. Suspicion of … Athletes often present to the physician’s office after a period of rest, lowering the diagnostic yield of physical examination. Patients who present with OCD of the capitellum are typically athletes between ages 11 and 21 years ( ). In: Morrey BF, Sanchez-Sotelo J, editors. Overhead athletes place the medial elbow stabilizing complex under significant repetitive stress with consequent lateral elbow compression and shear forces. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. The presence of these OCD lesions is now better recognized, but their etiology is often not known and is certainly multifactorial in many instances. However, its etiology remains unknown. Through a cadaveric ink-injection study of the skeletally mature elbow, determined that the main arterial contributors to the lateral elbow are the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. Yoshida T, Kim WC, Oka Y, Nakase M, Nishida A, Wada H, Arai Y, Kubo T. J Orthop. 2019 Mar;12(1):1-12. doi: 10.1007/s12178-019-09528-8. Philadelphia: WB Saunders; 2009. p. 288–96. Osteochondritis dissecans (OCD) of the capitellum is an injury that often afflicts young athletes, especially young gymnasts and baseball pitchers. proposed a classification scheme of capitellar OCD lesion stability based on T2-weighted MRI sequences. 2018 Aug;13(4):726-736. Nonetheless the use of ultrasound as a simple and noninvasive tool has been advocated by several writers as a way to screen young, susceptible athletes for asymptomatic lesions as well as to access vascularity of the lesion ( ). Finally, it also commonly occurs in persons who participate in racquet sports and in weight lifting. Athletes with OCD of the capitellum often complain of diffuse, nonspecific pain with activity. Stage I lesions appear as normally shaped capitellum with several spotted areas whose signal intensity is high but lower than that of cartilage. In the elbow, supplemental views such as 45 degrees flexion or oblique views may help to demonstrate the lesion. This scheme has been well adopted because of its relative ease of use; however, it has not been shown to correlate well with treatment outcomes ( ). Changes evolve on T2-weighted imaging as the lesion progresses ( ). Elbow involvement in osteochondritis dissecans is rare. The pathophysiology of OCD resembles that of mechanical trauma to articular cartilage. January 2021; DOI: 10.1007/978-3-030-52379-4_6. Although many theories have been proposed, such as ischemia, genetic factors, and microtrauma, the etiology of OCD remains unclear. Panner’s disease must be considered in the differential diagnosis of a young athlete with elbow pain. The most common early symptom of a capitellar OCD lesion is a gradual, progressive onset of lateral elbow pain. THE ALFRED I. DUPONT INSTITUTE . When rest is difficult to accomplish, bracing, use of a sling, or even a period of casting is used. Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. Please enable it to take advantage of the complete set of features! Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). We also believe that if the radiographs or MRI do not show separation of the fragment with fluid between the native and progeny bone, a period of rest has a decent chance to result in a full functional recovery in at least half of cases. CASE HISTORY: This Patient is a 14 year old right hand dominant male … This same phenomenon extends to OCD of the capitellum. 2018 Jul-Aug;52(4):344-352. doi: 10.4103/ortho.IJOrtho_322_17. This site needs JavaScript to work properly. 2017 Aug 10;14(4):515-519. doi: 10.1016/j.jor.2017.08.011. 2020 Nov 20;9(11):e1727-e1730. Gardiner TB. 32.6 ). Grade I Osteochondritis Dissecans in a Young Professional Athlete. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. 2008;33(8):1380–3. Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Am J Sports Med. OCD usually causes pain during and after sports. Osteochondritis Dissecans OCD of the capitellum is character-ized by noninflammatory degenera-tion of subchondral bone occurring in the context of repetitive loading to the lateralcompartmentoftheelbow.Pan-ner disease and OCD may represent two different stages of the same disor-der, but they differ in the patient’s age Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. described a method to visualize the articular surface and subchondral bone by utilizing long-axis and short-axis views of the anterior and posterior capitellum. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. 13. A grade IV lesion is either an empty defect, a defect with a dislocated fragment, or a loose fragment lying within the bed. Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. OCD of the capitellum is more commonly found in male adolescent athletes engaging in repetitive overhead activities and has been associated with baseball, gymnastics, tennis, weight lifting, wrestling, and cheerleading. Humeral capitellum osteochondritis dissecans is believed to affect 4.1 of every 1000 males. Int J Sports Phys Ther. Many classification systems have been proposed to help guide the diagnosis and management of capitellar OCD lesions. In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. Grade II lesions are stable when probed but demonstrate partial discontinuity. Among male relatives of affected males, the prevalence rate is 14.6%. Investigators have found high sensitivity (89% to 100%) of MRI for detecting unstable lesions when all four of the following Kijowski criteria are present: (1) a rim of high signal on T2-weighted images, (2) surrounding cysts, (3) a fluid-filled osteochondral defect, and (4) a thin high-intensity fracture line on T2-weighted images ( ). With this maneuver, passive forearm pronation and supination with the elbow in midrange flexion and extension during application of an axial load recreates pain at the radiocapitellar joint. In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. 2017 Sep;26(9):1629-1635. doi: 10.1016/j.jse.2017.03.010. Ultrasonography is another potential diagnostic imaging tool for capitellar OCD. Osteochondritis dissecans (OCD) of the humeral capitellum is a sports-related disorder in young athletes, especially baseball players and gymnasts. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. 4 . Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. In the evaluation for suspected osteochondritis dissecans of the capitellum, standard elbow radiographs, including anteroposterior (AP), oblique radial head, and lateral views, should be obtained ( Fig. Nonoperative treatment for osteochondritis dissecans of the capitellum. Genetic factors are thought to play a secondary role in the pathogenesis. MRI has proved useful for better characterizing OCD lesions and guiding treatment. The elbow and its disorders. Repetitive stress to and compression of this tenuous blood supply may cause ischemia of the subchondral bone within the capitellum and the characteristic osteonecrosis observed in OCD. 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