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Review
. 2016 Feb 18;7(2):102-8.
doi: 10.5312/wjo.v7.i2.102.

Osteochondritis dissecans of the capitellum in adolescents

Christiaan Ja van Bergen  1 , Kimberly Im van den Ende  1 , Bart Ten Brinke  1 , Denise Eygendaal  1
Affiliations
Review

Osteochondritis dissecans of the capitellum in adolescents

Christiaan Ja van Bergen et al. World J Orthop. .

Abstract

Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, an OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk. A high index of suspicion is warranted to prevent delay in the diagnosis. Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy. Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach. Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD. Numerous other surgical options have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this article is to provide a current concepts review of the etiology, clinical presentation, diagnosis, treatment, and outcomes of elbow OCD.

Keywords: Adolescent; Arthroscopy; Athletes; Bone marrow stimulation; Capitellum; Cartilage; Elbow; Osteoarthritis; Osteochondritis dissecans; Overhead sports.

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Figures

Figure 1
Figure 1
Vascularisation of the capitellum. A: Anterior view; B: Lateral view. Br: Brachial; IR: Interosseous recurrent; IUC: Inferior ulnar collateral; MC: Middle collateral; PUR: Posterior ulnar recurrent; R: Radial; RC: Radial collateral; RR: Radial recurrent; SUC: Superior ulnar collateral artery.
Figure 2
Figure 2
Plain radiography of the elbow showing an osteochondritis dissecans lesion of the capitellum. A: Anteroposterior; B: Lateral.
Figure 3
Figure 3
Magnetic resonance images of an elbow affected with osteochondritis dissecans of the capitellum. A: Coronal view; B: Sagittal view.
Figure 4
Figure 4
Computed tomography scans showing capitellar osteochondritis dissecans (A-C).
Figure 5
Figure 5
Patient positioning for arthroscopy of a right elbow (A and B). The patient is in the lateral decubitus position and the arm rests on a support.
Figure 6
Figure 6
Arthroscopic picture showing an osteochondritis dissecans lesion after debridement and microfracturing.
See this image and copyright information in PMC

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