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Osteochondritis Dissecans of the Humeral Capitellum: The Significance of Lesion Location.

Kolmodin J, Saluan P - Orthop J Sports Med (2014)

Bottom Line: To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion.Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes.There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin.

View Article: PubMed Central - PubMed

Affiliation: The Cleveland Clinic Foundation, Cleveland, Ohio, USA.

ABSTRACT

Background: There is a paucity of information regarding the effect of lesion location on surgical outcomes in the treatment of osteochondritis dissecans (OCD) of the humeral capitellum.

Purpose: To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum.

Study design: Systematic review; Level of evidence, 4.

Methods: All studies from the past 20 years were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum.

Results: Six studies met the inclusion criteria. Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes. There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin. The failure rate for nonreconstructive operative management for lateral lesions was noted to be significant, as failure rates for peg fixation of lateral lesions was seen to be as high as 44% (4/9) in one of the studies.

Conclusion: Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, are limited. The literature suggests that lesions located on the lateral capitellum-particularly those involving the lateral cartilage margin-require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location as a factor influencing surgical decision making.

No MeSH data available.


Related in: MedlinePlus

Type II osteochondritis dissecans lesion.
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fig2-2325967114530840: Type II osteochondritis dissecans lesion.

Mentions: In the proposed refined classification, type I lesions (“stable lesions”) have an open capitellar physis, a grade I radiographic lesion, and nearly full range of motion (ROM) at the time of diagnosis. Most of these lesions, if treated with thorough rest, will heal completely. Type II lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies medial to the radial head center line (Figure 2). These lesions tend to respond well to simple debridement or repair. Type IIIa lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies laterally to the radial head center line (Figure 3). These lesions tend to do better with more aggressive therapies (eg, repair or reconstruction). Type IIIb lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies laterally to the radial head center line, including the lateral cartilage margin (Figure 4). These lesions necessitate reconstruction.


Osteochondritis Dissecans of the Humeral Capitellum: The Significance of Lesion Location.

Kolmodin J, Saluan P - Orthop J Sports Med (2014)

Type II osteochondritis dissecans lesion.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555594&req=5

fig2-2325967114530840: Type II osteochondritis dissecans lesion.
Mentions: In the proposed refined classification, type I lesions (“stable lesions”) have an open capitellar physis, a grade I radiographic lesion, and nearly full range of motion (ROM) at the time of diagnosis. Most of these lesions, if treated with thorough rest, will heal completely. Type II lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies medial to the radial head center line (Figure 2). These lesions tend to respond well to simple debridement or repair. Type IIIa lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies laterally to the radial head center line (Figure 3). These lesions tend to do better with more aggressive therapies (eg, repair or reconstruction). Type IIIb lesions (“unstable lesions”) are those with a closed capitellar physis, a grade II/III lesion radiographically or present with restricted elbow ROM, and have a lesion that lies laterally to the radial head center line, including the lateral cartilage margin (Figure 4). These lesions necessitate reconstruction.

Bottom Line: To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion.Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes.There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin.

View Article: PubMed Central - PubMed

Affiliation: The Cleveland Clinic Foundation, Cleveland, Ohio, USA.

ABSTRACT

Background: There is a paucity of information regarding the effect of lesion location on surgical outcomes in the treatment of osteochondritis dissecans (OCD) of the humeral capitellum.

Purpose: To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum.

Study design: Systematic review; Level of evidence, 4.

Methods: All studies from the past 20 years were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum.

Results: Six studies met the inclusion criteria. Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes. There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin. The failure rate for nonreconstructive operative management for lateral lesions was noted to be significant, as failure rates for peg fixation of lateral lesions was seen to be as high as 44% (4/9) in one of the studies.

Conclusion: Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, are limited. The literature suggests that lesions located on the lateral capitellum-particularly those involving the lateral cartilage margin-require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location as a factor influencing surgical decision making.

No MeSH data available.


Related in: MedlinePlus