The involvement of the capitellum is more diffuse, with radiographs revealing loss of the normal contour of the capitellum ( ). It occurs in a younger age group (4–12 years) than capitellar OCD and is predominantly found in boys. An elbow ligamentous stability examination should be performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability. Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. A grade IV lesion is either an empty defect, a defect with a dislocated fragment, or a loose fragment lying within the bed. Each of these interventions has had variable short-term outcomes, and the ideal management strategy has yet to be determined. The Research in Osteochondritis of the Knee (ROCK) study group has come to define OCD as “a focal, idiopathic alteration of subchondral bone with risk of instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis” ( ). In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. With delayed presentation, patients may lack the terminal 15 to 30 degrees of elbow extension ( ). Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising. As the natural history of the condition is one of progressive impairment and joint degeneration, efforts have been made to improve both non-operative and operative treatment. A capitellar OCD prevalence study used ultrasound as the screening examination and found that it had a 100% positive predictive value. 2019 Mar;12(1):1-12. doi: 10.1007/s12178-019-09528-8. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes. NLM Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. For this reason, the senior author (CWN) often exercises athletes in the office (i.e., throwing baseballs) to provoke their symptoms. The pathophysiology of OCD resembles that of mechanical trauma to articular cartilage. 32.2 ). Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. described a method to visualize the articular surface and subchondral bone by utilizing long-axis and short-axis views of the anterior and posterior capitellum. Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. Yoshida T, Kim WC, Oka Y, Nakase M, Nishida A, Wada H, Arai Y, Kubo T. J Orthop. Furthermore, patients’ lesions often heal their and patients return to full activities despite the lack of full radiographic healing. 32.4 ). Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. Repetitive microtrauma in the susceptible elbow initiates fatigue fracture, resorption, and ultimately fragment separation from the underlying subchondral bone, as demonstrated by through rabbit models. Introduction. Radiographs are the most common initial modality for screening patients with suspected OCD. Patients may also complain of accompanying elbow stiffness and loss of motion. Grade III lesions are associated with loose bodies. Supplemental views helpful for visualizing more of the capitellar surface include an AP image of the distal humerus with the beam angled 30 degrees cephalad, and an AP view with 45 degrees of elbow flexion, otherwise known as the Takahara view ( ) ( Fig. Osteochondritis dissecans of the capitellum in fraternal twins: case report. Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. Investigators have found high sensitivity (89% to 100%) of MRI for detecting unstable lesions when all four of the following Kijowski criteria are present: (1) a rim of high signal on T2-weighted images, (2) surrounding cysts, (3) a fluid-filled osteochondral defect, and (4) a thin high-intensity fracture line on T2-weighted images ( ). Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. OCD can mean one or more flakes of articular cartilage have become separated. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Osteochondritis Dissecans of the Capitellum, Lateral: Extensor Carpi Radialis Brevis Tendon Injury, Prevention in Youth Sports (Early Sports Specialization): Injuries of the Throwing Shoulder. Int J Sports Phys Ther. Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). Elbow involvement in osteochondritis dissecans is rare. Unfortunately, the ability to prognosticate when conservative treatment will be successful is not well established, and the decision whether to initiate nonoperative versus operative management in capitellar OCD focuses on the extent of disease, the time from onset of symptoms, and the patient’s expectations and desires. Stage II is marked by several spotted areas of higher intensity than cartilage. Capitellar osteochondritis dissecans (OCD) is one of the most common causes of elbow pain and dysfunction in adolescent athletes. January 2021; DOI: 10.1007/978-3-030-52379-4_6. 14. Side view of a pitcher at the point of maximal shoulder and elbow stress. This site needs JavaScript to work properly. Grade I Osteochondritis Dissecans in a Young Professional Athlete. A case report. Philadelphia: WB Saunders; 2009. p. 288–96. 2017 Sep;26(9):1629-1635. doi: 10.1016/j.jse.2017.03.010. The presence of these OCD lesions is now better recognized, but their etiology is often not known and is certainly multifactorial in many instances. In more severe cases, athletes may develop mechanical symptoms, such as catching, clicking, and locking, suggesting the presence of intraarticular loose bodies. These lesions, although often asymptomatic, can cause a significant interruption in a young athlete’s sports participation and in his or her day-to-day lives when the disease goes undiagnosed or is allowed to progress until significant symptoms occur. The treatment of patients with capitellar osteochondritis dissecans is primarily determined by the stability of the osteochondritis dissecans lesion. Epub 2008 Dec 4. 2009 Feb;37(2):298-304. doi: 10.1177/0363546508324970. In the talus, 96% of lateral lesions and 62% of … Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. An arthroscopic classification was developed by and later modified by the International Cartilage Repair Society. 32.5 ). Must distinguish from Panner’s Disease, transient osteonecrosis of the capitellum which typically occurs at younger ages, 5-12yo. Osteochondritis dissecans (OCD) of the elbow is increasing in prevalence in American pediatric populations. 4th ed. The separated fragments are sometimes called “joint mice”. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. The elbow and its disorders. proposed a classification scheme of capitellar OCD lesion stability based on T2-weighted MRI sequences. 2020 Nov 20;9(11):e1727-e1730. Takeba, J, Takahashi, T, Hino, K, Watanabe, S, Imai, H, Yamamoto, H. Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. THE ALFRED I. DUPONT INSTITUTE . However, its etiology remains unknown. Seen primarily in young overhead athletes such as baseball players, the condition is thought to be secondary to repetitive compressive and shearing forces that are exerted by the radial head on the humeral capitellum during the throwing motion. Osteochondritis dissecans in … In the long term OCD can lead to subsequent dege… Physical examination reveals tenderness over the radiocapitellar joint in the posterolateral elbow in some cases. Currently, the key to successful treatment is early detection. 2018 Jul-Aug;52(4):344-352. doi: 10.4103/ortho.IJOrtho_322_17. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. OSTEOCHONDRITIS DISSECANS OF THE CAPITELLUM . Osteochondritis dissecans. In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. OCD of the humeral capitellum remains a difficult problem to treat. CrossRef Google Scholar. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Stage III lesions show a discontinuous and noncircular capitellum chondral surface. Osteochondritis dissecans of the capitellum. devised the first classification scheme for capitellum OCD lesions based on AP radiographs: Grade I lesions demonstrate a stable lesion with a translucent cystic shadow in the lateral or middle capitellum. OCD of the capitellum is more commonly found in male adolescent athletes engaging in repetitive overhead activities and has been associated with baseball, gymnastics, tennis, weight lifting, wrestling, and cheerleading. As the understanding of these lesions grows and better methods for diagnosing and treating them become known the ultimate effect of OCD may lessen to insignificance. devised a more simplified classification, assigning lesions as stable or unstable. COVID-19 is an emerging, rapidly evolving situation. Many writers suggest that the timeline may be as long as 6 months to allow complete healing.  |  It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Osteochondritis dissecans also occurs in females, most notably gymnasts. Shaughnessy WJ. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. Clin Sports Med. A major disadvantage of ultrasound is the high variability in its accuracy, which is based on the skill and experience of the operator ( ). Osteochondritis dissecans (OCD) of the capitellum is an injury that often afflicts young athletes, especially young gymnasts and baseball pitchers. A plain anteroposterior radiograph with the elbow in 45° of flexion is … Osteochondritis Dissecans of the Capitellum. Osteochondritis Dissecans of the Capitellum. Typically it is seen in gymnasts or baseball players with repetitive compression to the outside of the elbow. Genetic factors are thought to play a secondary role in the pathogenesis. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. However, we are very careful with this treatment arm of the algorithm because the elbow loses functional range of motion faster than most joints in the body when it is immobilized. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities.  |  Late findings include the presence of loose bodies, degenerative changes, and radial head enlargement. Stage IV lesions are characterized by separation from the capitellum chondral surface by a high signal interface. Changes evolve on T2-weighted imaging as the lesion progresses ( ). In later stages, the capitellar surface may flatten and the lesion is often surrounded by a rim of sclerotic bone ( ). Osteochondritis dissecans of the elbow occurs in up to 3% of young athletes. If conservative treatment is not possible or fails, surgical options include open debridement with fragment excision, arthroscopic debridement and marrow stimulation, fragment fixation, closing wedge osteotomy of the distal humerus, osteochondral autograft, and osteochondral allograft. Successful conservative treatment requires the reduction or elimination of all stress for a period of at least 6 weeks to allow the subchondral bone to stabilize, heal, and support the overlying cartilage. Nonoperative treatment for osteochondritis dissecans of the capitellum. Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. This scheme has been well adopted because of its relative ease of use; however, it has not been shown to correlate well with treatment outcomes ( ). Grade II lesions possess a clear zone between the lesion and the adjacent subchondral bone. Clin Sports Med. Based on these imaging findings a diagnosis of osteochondritis dissecans (OCD) of the capitellum was made. Diagnosis and treatment. Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. The elbow is positioned in approximately 45 degrees of flexion with the beam aimed perpendicular to the forearm. From Crotin RL. Athletes often present to the physician’s office after a period of rest, lowering the diagnostic yield of physical examination. Finally, it also commonly occurs in persons who participate in racquet sports and in weight lifting. 32.1 ). doi: 10.1016/j.eats.2020.07.022. On ultrasound, loss of the smooth articular surface served as an excellent indicator of an OCD . 32.6 ). OCD usually causes pain during and after sports. Keywords: elbow, osteochondritis dissecans, baseball INTRODUCTION Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent athletes and generally af-fects those, such as baseball players and gymnasts, who engage in repetitive overhead or weight-bearing activities involving the upper extremities. Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. eCollection 2020 Nov. Logli AL, Bernard CD, O'Driscoll SW, Sanchez-Sotelo J, Morrey ME, Krych AJ, Camp CL. Repetitive stress to and compression of this tenuous blood supply may cause ischemia of the subchondral bone within the capitellum and the characteristic osteonecrosis observed in OCD. Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Am J Sports Med. In the evaluation for suspected osteochondritis dissecans of the capitellum, standard elbow radiographs, including anteroposterior (AP), oblique radial head, and lateral views, should be obtained ( Fig. Use of repeated imaging, although intuitively a good idea, is not established as a viable method to determine the appropriate timing of return to activities. Provoking compressive forces on the capitellum commonly occur in the dominant arm of overhead throwing athletes and from weight-bearing stress in gymnasts in the second decade of life. Osteochondritis dissecans of the capitellum: lesion size and pattern analysis using quantitative 3-dimensional computed tomography and mapping technique. Arthrosc Tech. JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery. Classic radiography finding of capitellar OCD with radiolucency of the anterolateral capitellum. Gymnasts, in general, fare … June 4, 1996. J Shoulder Elbow Surg. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Knee Surg Sports Traumatol Arthrosc. Panner’s disease must be considered in the differential diagnosis of a young athlete with elbow pain. Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. Axillary radiographic view of the elbow. Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. Grade III lesions show complete discontinuity but have not dislocated. Elbow radiographs may be normal in the early stages of OCD of the capitellum. A disadvantage to consider with CT is the radiation exposure imparted on the young athlete. Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. Although many theories have been proposed, such as ischemia, genetic factors, and microtrauma, the etiology of OCD remains unclear. Osteochondritis dissecans of the capitellum is an uncommon cause of lateral elbow pain in adolescents and young adults. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. For a general discussion of osteochondritis dissecans refer to the parent article - osteochondritis dissecans. In early-stage lesions, the T1-weighted MR image demonstrates uniform low-intensity changes in the superficial capitellum, although the T2-weighted imaging findings remain normal. A collaborative approach to prevent medial elbow injuries in baseball pitchers. 2. The blood supply to the capitellum arises primarily from posterior perforating vessels that traverse the epiphyseal articular cartilage without metaphyseal collateral circulation ( ). Patients who present with OCD of the capitellum are typically athletes between ages 11 and 21 years ( ). As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). NIH This occurs primarily during the late cocking phase of the throwing cycle as the radiocapitellar articulation, a prime secondary stabilizer to valgus stress, experiences as much as 60% of the axial compression force across the elbow ( Fig. In this system, grade I lesions are stable with continuous but softened areas of intact cartilage. Arthroscopy. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The etiology of this disorder is multifactorial and often cannot be determined. With time, the overlying articular cartilage begins to break down and is increasingly vulnerable to shear stress because of inadequate subchondral osseous support, leading to separation, fragmentation, and loose body formation ( ). Osteochondritis dissecans (OCD) of the capitellum is an overuse injury most commonly seen in young overhead athletes such as throwers and gymnasts. Ultimately, repetitive stress of this nature leads to disruption of a localized portion of the subchondral bone and, if allowed to progress, the overlying articular cartilage. 2008;33(8):1380–3. Osteochondritis Dissecans of the Elbow. Osteochondritis dissecans (OCD) of the outer elbow side of the arm bone, or capitellum, is a condition that results from repetitive trauma to the capitellum. The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. 4 . The lesions can be treated by either conservative or operative methods with good to excellent results reported in most situations. CRAIG MORGAN, M.D., Attending, Orthopaedic Surgery. Please enable it to take advantage of the complete set of features! Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. CLINICAL CASE PRESENTATION . WILMINGTON, DELAWARE . The dominant arm is more commonly involved, although bilateral involvement has been reported ( ). Elbow is flexed 110 to 120 degrees, and the shoulder is slightly externally rotated. USA.gov. On the contrary, unstable lesions possess one of the following characteristics: a closed capitellar growth plate, lesion fragmentation, or restricted elbow motion ≥ 20 degrees. However, once an athlete complains of clicking or locking, regardless of the timeliness of diagnosis and the patient’s age, the likelihood that conservative management will be successful decreases. Developed by and later modified by the International cartilage Repair Society separation from the osteochondritis dissecans capitellum underlying subchondral bone separated! Found that it had a 100 % positive predictive value primarily in the.... 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