George Andrew, Holderread Brendan M, Phelps Brian M, Erwin Emily R, Singer William, Jack Robert A
Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA.
JSES Int. 2023 Nov 30;8(2):355-360. doi: 10.1016/j.jseint.2023.11.003. eCollection 2024 Mar.
Osteochondritis dissecans (OCD) of the capitellum is a well-described condition that most commonly affects adolescent throwing athletes and gymnasts. There is no gold standard rehabilitation protocol or timing for return to sport (RTS) after surgical management of OCD of the capitellum.
HYPOTHESIS/PURPOSE: The purpose of the study was to identify in the existing literature any criteria used for RTS following surgical treatment of OCD of the capitellum. The hypothesis was that surgeons would utilize length of time rather than functional criteria or performance benchmarks for RTS.
Level 1 to 4 studies evaluating athletes who underwent surgery for OCD of the capitellum with a minimum follow-up of 1-year were included. Studies not describing RTS criteria, including less than 1-year follow-up, non-operative management only, and revision procedures were excluded. Each study was analyzed for RTS criteria, RTS rate, RTS timeline, sport played, level of competition, graft source (if utilized), and postoperative rehabilitation parameters. Assessment of bias and methodological quality was performed using the Coleman methodology score and RTS value assessment.
All studies reported a rehabilitation protocol with immobilization followed by bracing with progressive range of motion. RTS rate was 80.9% (233/288). The majority of studies reported using time-based criteria for RTS (11/15). The most commonly reported timeline was 6 months (range: 3-12 months).
The overall RTS rate after surgical treatment of capitellar OCD is high with no consensus on RTS criteria. The two most consistent RTS criteria reported in the literature are return of elbow range of motion and healing demonstrated on postoperative imaging. There is a wide range of time to RTS in the literature, which may be sport dependent. Further research is needed to develop functional and performance-based metrics to better standardize RTS criteria and rehabilitation protocols.
肱骨小头剥脱性骨软骨炎（OCD）是一种已被充分描述的病症，最常影响青少年投掷运动员和体操运动员。对于肱骨小头OCD手术治疗后的康复方案或恢复运动（RTS）时间，尚无金标准。
假设/目的：本研究的目的是在现有文献中确定肱骨小头OCD手术治疗后用于RTS的任何标准。假设是外科医生会使用时间长度而非功能标准或表现基准来确定RTS。
纳入1至4级研究，评估接受肱骨小头OCD手术且随访至少1年的运动员。排除未描述RTS标准的研究，包括随访少于1年、仅非手术治疗以及翻修手术。对每项研究分析RTS标准、RTS率、RTS时间线、所从事运动、比赛水平、移植来源（如使用）以及术后康复参数。使用科尔曼方法评分和RTS值评估进行偏倚和方法学质量评估。
所有研究均报告了康复方案，先固定，然后使用支具并逐步增加活动范围。RTS率为80.9%（233/288）。大多数研究报告使用基于时间的标准来确定RTS（11/15）。最常报告的时间线是6个月（范围：3 - 12个月）。
肱骨小头OCD手术治疗后的总体RTS率较高，但对于RTS标准尚无共识。文献中报告的两个最一致的RTS标准是肘关节活动范围恢复和术后影像学显示愈合。文献中RTS的时间范围很广，这可能取决于运动项目。需要进一步研究以制定基于功能和表现的指标，以更好地规范RTS标准和康复方案。
