Osteochondritis in the female gymnast's elbow

Abstract

Ten cases of osteochondritis dissecans of the humeral capitellum are reviewed in seven high-performance female gymnasts, ranging in age from 10 to 17 years old. All but one were evaluated and treated with arthroscopy and/or arthrotomy, with curettage of loose articular margins, drilling of the lesion, and removal of loose bodies. The average length of follow-up is 2.9 years, and includes interview, physical examination, and roentgenographic evaluation. This injury has been previously described in relation to compressive forces across the radiocapitellar joint from repetitive valgus loading in a developing epiphysis. Only one of the athletes, at the time of follow-up, was still in competitive gymnastics. Each has a minimal limitation in range of motion, with crepitus and often catching noted by history and on examination. These cases double the limited literature on this injury in young, female gymnasts. They stimulate concern for the proper and early evaluation and treatment of elbow injuries in this at risk group. Once the bony changes in the capitellum are detected, and pain remains despite conservative management, we have found that symptoms can be improved with surgery, but persist in female gymnasts. Our experience in this more-advanced group is that the return to high-level competitive gymnastics is unlikely.