Five-Year Follow-up of Adolescent Gymnasts After Surgical Treatment of Osteochondritis Dissecans of the Elbow

Shannon Yehyawi; Emily Marie Zielinski; Mykola Bartkiw; Kathryn Peck; Hill Hastings 2nd

doi:10.1016/j.jhsa.2022.12.009

Five-Year Follow-up of Adolescent Gymnasts After Surgical Treatment of Osteochondritis Dissecans of the Elbow

J Hand Surg Am. 2023 Apr 28:S0363-5023(22)00770-5. doi: 10.1016/j.jhsa.2022.12.009. Online ahead of print.

Authors

Shannon Yehyawi¹, Emily Marie Zielinski², Mykola Bartkiw³, Kathryn Peck⁴, Hill Hastings 2nd⁵

Affiliations

¹ Columbia Orthopaedic Group, Columbia, MO.
² Department of Orthopedic Surgery, Indiana University School of Medicine, IU Health University Hospital, Indianapolis, IN.
³ Department of Orthopaedic Surgery, Michigan State University College of Osteopathic Medicine, East Lansing, MI.
⁴ Indiana Hand to Shoulder Center, Indianapolis, IN. Electronic address: kpeck@ihtsc.com.
⁵ Telluride Hand Surgery, Telluride, CO; Indiana Hand to Shoulder Center, Indianapolis, IN; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.

PMID: 37115144
DOI: 10.1016/j.jhsa.2022.12.009

Abstract

Purpose: Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition.

Methods: A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows.

Results: Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition.

Conclusions: The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport.

Type of study/level of evidence: Therapeutic IV.

Keywords: OCD treatment; elbow OCD; elbow arthroscopy; elbow sports injury; gymnast OCD lesion; gymnastics; osteochondritis dissecans; return to sport.