2015 ISAKOS Biennial Congress ePoster #1004

Imaging of Osteochondritis Dissecans of the Capitellum: X-Ray, MRI or CT?

Kimberly Ineke Mariska Van Den Ende, MD, Rotterdam NETHERLANDS
Renee Keijsers, MD, Utrecht NETHERLANDS
Michel Van Den Bekerom, MD, Amsterdam NETHERLANDS
Denise Eygendaal, Prof., MD, PhD, Breda NETHERLANDS
Amphia Hospital, Breda, NETHERLANDS

FDA Status Not Applicable

Summary: Imaging of OCD of the Capitellum by X-Ray, MRI or CT were compared with arthroscopic findings in 25 patiënts; a CT scan is the best imaging technique to confirm diagnosis

Abstract:

Introduction

Osteochondritis dissecans (OCD) of the capitellum of the elbow is an injury seen in young athletes (12-18 years of age) in overhead sports. Unfortunately, obtaining a definite diagnosis can be a time-consuming process in these talented athletes.
Which is the best radiological technique to diagnose OCD of the capitellum?

Methods

Between 2008-2013, 106 young patients with suspected OCD were subjected to arthroscopy of the elbow. Of 25 patients pre-operative X-ray, MRI and CT are available.
Two experienced surgeons, specialized in the upper extremity, have assessed whether or not the osteochondral lesion could be identified using the various imaging techniques and classified it according to the classification of The Clanton and DeLee, Itsubo and Minami for CT, MRI and X-ray respectively. These results were compared with findings at arthroscopy.

Results

In 6 (24%) of the 25 elbows, the lesion was not visible on X-ray. 5 out of these 6 lesions were visible on MRI and all 6 on CT. Without exception, lesions visible on X-ray were seen on both MRI and CT. In 20 patients, 1 or 2 loose bodies were found during surgery, consistent with OCD. Pre-operatively this was seen in 11 (55%) of the X-rays, 13 (65%) MRIs, and in 18 (90%) CT scans.

Conclusion

An OCD lesion of the capitellum is not always visible on X-ray. A CT of the elbow seems to be the best imaging technique to confirm the diagnosis of OCD. Loose bodies are often missed, especially on standard X-rays and MRIs.