Clinical outcomes of osteochondritis dissecans lesions of the capitellum treated with arthroscopy with a mean follow-up period of 8.3 years

Abstract

Background and hypothesis: Although numerous studies exist evaluating the short-term clinical outcomes of patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes in a large cohort of patients is limited. We hypothesized that the clinical outcomes of patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores and with an acceptable return-to-play rate.

Methods: A retrospective analysis of a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. The inclusion criteria for this study included a diagnosis of OCD of the capitellum treated arthroscopically with a minimum 2-year follow-up period. The exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and cases in which any portion of the surgical procedure was performed in an open manner. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons-Elbow (ASES-e), Andrews-Carson, and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC) questionnaires and our institution-specific return-to-play questionnaire.

Results: After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted, for a follow-up rate of 84%. The mean age was 15.2 years, and the mean follow-up time was 8.3 years. A subsequent revision procedure was performed in 11 patients, for a 12% failure rate in these patients. The ASES-e pain score was an average of 4.0 on a maximum pain scale of 100, the ASES-e function score was an average of 34.5 of a maximum of 36, and the surgical satisfaction score was an average of 9.1 of 10. The average Andrews-Carson score was 87.1 of 100, and the average KJOC score for overhead athletes was 83.5 of 100. Additionally, of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play.

Conclusion: This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up period.

Keywords: Elbow; arthroscopy; baseball; osteochondritis dissecans; overhead athlete; sports medicine.