Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands.
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
Am J Sports Med. 2018 Oct;46(12):2954-2959. doi: 10.1177/0363546518790455. Epub 2018 Aug 24.
Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow.
To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD.
Case series; Level of evidence, 4.
Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good-complete osseous union or ossification; fair-incomplete osseous union or ossification but improved; poor-no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan.
There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05).
Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.
关节镜下清创和微骨折被认为是治疗肱骨滑车骨软骨剥脱症（OCD）的主要手术方法。软骨下骨的愈合对于软骨修复至关重要，而缺乏愈合则与骨关节炎的发展有关。迄今为止，尚不清楚在肘部进行这种技术后，软骨下骨的愈合程度如何。
通过 CT 分析关节镜下清创和微骨折治疗晚期肱骨滑车 OCD 的缺损大小变化和软骨下骨愈合情况。
病例系列；证据水平，4 级。
2009 年至 2016 年，67 例患者因晚期肱骨滑车 OCD 行关节镜下清创和微骨折术。54 例（81%的随访率）患者行 CT 扫描（平均±标准差：术前，4.0±1.7 个月；术后，29±9.0 个月）。OCD 缺损大小通过测量 3 个方向的最大直径来评估：内外侧方向（冠状面）和前后方向及深度（均在矢状面）。OCD 的愈合分为 3 类：良好-完全骨融合或骨化；尚可-不完全骨融合或骨化但改善；不良-术前和术后扫描无变化。同时进行术后 CT 扫描，评估术后牛津肘部评分（OES）。
30 例为女性，24 例为男性（年龄，15.7±3.2 岁）。所有 3 个方向（内外侧×前后×深度）的缺损大小均减小（P<0.001）：术前为 7.9±2.8×8.0±3.2×4.1±1.5mm；术后为 3.5±3.3×4.0±3.5×1.6±1.4mm。软骨下骨愈合情况评定为优 19 例（35%），良 27 例（50%），差 8 例（15%）。术后 OES 平均评分为 40±8.4。术后缺损大小和愈合分级均与 OES 无相关性（P>0.05）。
关节镜下清创和微骨折治疗晚期肱骨滑车 OCD，平均随访 29 个月后，缺损大小在宽度和深度上均有改善（即减小）。软骨下骨的愈合情况为优或良者占 85%。有趣的是，CT 发现与临床结果无相关性。
