Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, MN 55345, USA.
Am J Sports Med. 2012 Nov;40(11):2549-56. doi: 10.1177/0363546512458765. Epub 2012 Sep 26.
Osteochondritis dissecans (OCD) of the capitellum affects young athletes involved in elbow load-bearing activities. Unstable lesions are best managed surgically, although debate remains regarding the optimal method. Arthroscopic treatment allows rapid recovery, but the effect on the articular surface is undetermined.
The clinical outcome after arthroscopic microfracture of stage III/IV capitellum OCD would be successful in terms of return to sport and restoration of function, and there would be some evidence of articular restoration or repair.
Case series; Level of evidence, 4.
We reviewed records of 10 consecutive adolescent patients (age ≤18 years) with stage III or IV OCD lesions of the capitellum managed with arthroscopic microfracture. The mean age at the time of surgery was 13.9 years (range, 10.8-18.5 years); 7 patients were skeletally immature and 3 were skeletally mature. Pre- and postoperative functional assessment included active range of motion, Mayo Elbow Performance Score (MEPS), and Timmerman/Andrews elbow score. All patients underwent plain radiographic and magnetic resonance imaging (MRI) evaluation at a minimum of 12 months (mean, 27 months; range, 12-49 months) and clinical evaluation at a minimum of 24 months (mean, 42 months; range, 27-54 months) after surgery.
The mean range of motion improved in both flexion (135.8°→140.7°, P = .112) and extension (20.4°→-2.2°, P = .005). The mean MEPS (70.5→97, P = .007) and Timmerman/Andrews elbow scores (116.4→193.0, P = .008) improved significantly. magnetic resonance imaging (MRI) evaluation demonstrated an improvement in overall joint congruence and the formation of a reparative articular surface in 8 of 10 (80%) patients. No reoperations or major complications were encountered. Six of 8 patients involved in competitive athletics returned to the same level of participation at an average of 5.1 months.
Arthroscopic OCD fragment excision and capitellar microfracture demonstrates good to excellent functional results in short-term follow-up. Follow-up MRI suggests potential for a reparative fibrocartilaginous articular surface. Longer term follow-up is necessary to determine durability of the technique.
肱骨小头剥脱性骨软骨炎（OCD）影响参与肘部负重活动的年轻运动员。不稳定的病变最好通过手术治疗，尽管关于最佳方法仍存在争议。关节镜治疗允许快速恢复，但对关节表面的影响尚不确定。
在关节镜下对 III/IV 期肱骨小头 OCD 进行微骨折治疗后，在重返运动和功能恢复方面将取得成功，并且有一些关节修复或修复的证据。
病例系列；证据水平，4 级。
我们回顾了 10 例连续接受关节镜下微骨折治疗的 III 或 IV 期肱骨小头 OCD 病变的青少年患者（年龄≤18 岁）的记录。手术时的平均年龄为 13.9 岁（范围，10.8-18.5 岁）；7 例骨骼未成熟，3 例骨骼成熟。术前和术后的功能评估包括主动活动范围、梅奥肘部功能评分（MEPS）和蒂曼/安德鲁斯肘部评分。所有患者均在至少 12 个月（平均 27 个月；范围 12-49 个月）进行了至少 12 个月的常规 X 线和磁共振成像（MRI）评估，并在至少 24 个月（平均 42 个月；范围 27-54 个月）后进行了临床评估。
在屈曲（135.8°→140.7°，P =.112）和伸展（20.4°→-2.2°，P =.005）方面，平均活动范围均有所改善。MEPS（70.5→97，P =.007）和蒂曼/安德鲁斯肘部评分（116.4→193.0，P =.008）均显著提高。MRI 评估显示 10 例中有 8 例（80%）的整体关节吻合度改善，形成了修复性关节表面。未进行再次手术或发生重大并发症。8 例中有 6 例参与竞技运动的患者平均在 5.1 个月后恢复到相同的参与水平。
关节镜 OCD 碎片切除和肱骨小头微骨折在短期随访中显示出良好至优秀的功能结果。随访 MRI 表明有修复纤维软骨关节面的潜力。需要更长时间的随访以确定该技术的耐用性。
