Hello, this is Scott Steinman, and I will be discussing elbow osteochondritis desiccans. Disclosures. An interesting study from Japan looked at over 1,000 baseball players of school age, none had OCD, but ultrasound examination, if there was an abnormal finding, they went on to an MRI, and they found an incidence of almost 2%. The part that was interesting is that only 35% of patients that had early OCD reported elbow pain. So it's interesting that if you can identify this early before players actually have symptoms, it might be very helpful at that point to intervene. We do know that the long-term results of OCD can lead to approximately 50% incidence of impaired motion or pain at long-term follow-up of 23 years and in one other study at 13 years. Non-operative management in this study of almost 100 patients in early stage, 54% healed at a mean of eight months, which is a fair amount of time, with activity restriction. So if you can identify this in the early stages, the results are good with non-operative treatment. Professor Awasaki has shown that doing the OATS procedure and osteochondral autograft can get excellent results and return to sport. David Roos looked at patients with a pure arthroscopic management with no attempt to drill into the bone and showed very good short-term results at three years. However, placing autografts can be fun, but we have to be careful with this procedure. We can place multiple mosaic-type grafts. Complications of plugs can occur. Here's a patient that was sent to me 14 years after failed non-operative treatment, had plugs placed, and you can see one year post-surgery, the arthritic changes at the radial head and the capitellum, very poor motion. In the operating room, we opened up and saw the arthritic situation of the joint. We then removed the plugs. Here we can see the resected radial head, post-operative range of motion, intra-op was quite good. Post-operatively, we can see the patient one year later has less pain, better motion, but not a perfect result. Maybe the safer early intervention. Avascular necrosis of the capitellum is a form of extreme OCD, so to speak. This case here is a good example, avascular necrosis. This young female is demonstrating all of her extension, which is stuck at about 60 degrees. She did have a prior arthroscopy a year before, but I saw only two portals used. Here we can see the X-rays, CT scan shows the extensive involvement of the capitellum. Here we can see the capitellum acts like a very large OCD legion. We did extensive debridement. Here is a result one week later, and a result at one year follow-up, demonstrating the benefits of elbow arthroscopy. We did look at some newer portals for exposure. We reported this previously of a more orthogonal approach to the OCD lesion. Here this is demonstrated in the operating room, keeping an orthogonal approach to avoid sword fighting with the instruments. And here you can see the distal ulnar portal placed under the ankinaeus, leading to direct view of the lesion itself. Here is a case, 14-year-old male with a large lesion, no history of trauma. We can see the CT scan, intraoperative. We are using the distal ulnar portal for viewing of the lesion. We can see the sequential steps of the procedure. We did do a microfracture here. At one year post-op, he had full activities, full range of motion, with no complaints. We actually saw him at five years follow-up for his shoulder. We took some views of his elbow, and he had no complaints at his elbow. Here's another case. This was sent to me by Mark Cohen, 14-year-old high school quarterback. He had a significant large lateral lesion. He had significant arthroscopic debridement performed. He had an eight-year follow-up. He completed university football and was entering the NFL draft with no elbow symptoms. Here's an example of another patient with a large lateral lesion that we treated arthroscopically. Results from the Netherlands of 67 patients getting a post-operative CT scan at 29 months showed that the defect size decreased in all directions after arthroscopic debridement. Interesting, the CT findings of size of healing did not correlate with the clinical outcomes. A study looking at using a costal osteochondral autograph by Dr. Sato in Japan, 72 patients did very well and no chest complications in his series. A large series of 75 patients from the Netherlands also showed no relationship between lateral wall involvement. There were only two baseball players in this series. 62% returned to sport, mainly tennis and gymnastics, and there were no complications. So in conclusion, the best treatment, I believe, is early detection and prevention and activity modification. Arthroscopic debridement is effective for partial or loose lesions. Lateral wall involvement can also be treated arthroscopically. And autograph transplantation has also been shown to be very effective for large lesions. Thank you very much.

elbow osteochondritis dissecans

early detection

non-operative management

surgical procedures

case studies