2015 ISAKOS Biennial Congress ePoster #501
Arthroscopic Osteochondral Fixation for Elbow Osteochondritis Dissecans in Teenage Baseball Players
Jun Takeba, MD, PhD, Toon, Ehime JAPAN
Toshiaki Takahashi, MD, PhD, Prof., Toon, Ehime JAPAN
Seiji Watanabe, MD, Toon, Ehime JAPAN
Hiroshi Imai, MD, PhD, Toon, Ehime JAPAN
Hiromasa Miura, MD, PhD, Prof., Toon, Ehime JAPAN
Deparment of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, JAPAN
FDA Status Not Applicable
Summary: We demonstrated favorable clinical results after arthroscopic osteochondral fragment fixation in teenage baseball players with elbow OCD, albeit with a short follow-up period, and a large proportion of the patients were able to resume playing baseball. This technique is considered appropriate for detached-phase OCD in patients during the adolescent growth spurt.
There are no previously published reports on the clinical results of treatment involving arthroscopic fixation of unstable osteochondral fragments for osteochondritis dissecans (OCD) of the elbow. In this study we assessed the indications for this procedure, performed using absorbable pins, and evaluated clinical outcomes over a postoperative period of at least one year. We hypothesized that arthroscopic osteochondral fragment fixation techniques would be comparable to previous reports in terms of functional outcomes and rate of return to baseball activities.
SUBJECTS & METHODS
The patients were 15 adolescent baseball players with a mean age of 14.3 years (range, 12 to 16 years) who had OCD of grades II to IV based on the International Cartilage Repair Society system. No displacement of primary lesions was identified. There were 2, 8, and 5 patients with OCD of grades II, III, and IV, respectively. Epiphyses were open in two patients and closed in 13.
The patients were placed in a lateral position. In order to examine the anterior part of the humeral capitellum, the elbow was flexed by at least 90°. Arthroscopic fixation was carried out using three to five poly-L-lactide or hydroxyapatite absorbable pins that were 1.5 mm in diameter and 15 mm long, with two direct lateral working portals.
Patients were evaluated using the following validated outcome measures, with a mean follow-up period of 22 months (range, 12 to 50 months). The disability/symptoms and sports sections of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were used to assess each patient’s reported outcomes. Additional questions were used to evaluate the resumption of sports activities.
Statistical analysis was performed with paired t-tests to detect any differences between preoperative and follow-up range of motion and DASH scores. P < 0.05 was considered statistically significant.
The DASH disability/symptom score improved from 13 (SD, 6.8) to 1 (SD, 1.2) (P < 0.00001), and the DASH sports score improved from 72 (SD, 29.5) to 1 (SD, 4.8) (P<0.00001). Mean extension improved from -11° (SD, 10.7) to -2° (SD, 3.7) (P = 0.0015). Mean flexion improved from 128° (SD, 12.8) to 136° (SD, 6.8) (P = 0.021). Of the 15 patients, 14 (93%) were able to resume playing baseball, and 10 (67%) resumed at the same position as before the injury.
One advantage of this technique is that it is minimally invasive, resulting in a favorable postoperative range of motion. We demonstrated favorable clinical results after arthroscopic osteochondral fragment fixation in teenage baseball players with elbow OCD, albeit with a short follow-up period, and a large proportion of the patients were able to resume playing baseball. This technique is considered appropriate for detached-phase OCD in patients during the adolescent growth spurt.