Lane Gabriel, Smith Matthew V, Goldfarb Charles A, Coronado Rogelio A, Bowman Eric N
Meharry Medical College, Nashville, TN, USA.
Washington University in St. Louis, Chesterfield, MO, USA.
JSES Rev Rep Tech. 2024 Mar 28;4(3):563-570. doi: 10.1016/j.xrrt.2024.02.011. eCollection 2024 Aug.
Capitellar osteochondritis dissecans (OCD) lesions are common in athletes. Osteochondral autograft transfer (OAT) is one possible treatment option, though outcomes including return to sport (RTS) data are limited to small series. The purpose of this study was to systematically review RTS following OAT for capitellar OCD lesions. Our secondary objectives were to evaluate patient-reported outcomes (PROs), range of motion (ROM), and complications after OAT.
PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched for peer-reviewed articles on "osteochondral autograft transfer" and related terms for capitellar OCD lesions. Articles were included if they reported an RTS rate and had a follow-up time point of at least 12 months. Data on RTS rates, PRO measures, complications, and ROM were extracted. Articles were assessed for methodological quality using the Methodological Index for Non-randomized Studies criteria.
Six hundred sixty-six articles were retrieved, and 24 articles (470 patients) met the inclusion criteria. In total, 454/470 patients (97%) returned to sports following OAT for OCD. The RTS rate ranged from 79% to 100%. Return to previous level of performance ranged from 10% to 100%. Timmerman-Andrews postoperative scores (range = 169-193) were most often reported, with 87% of patients showing scores within the excellent range. Disabilities of the Arm, Shoulder, and Hand and Japanese Orthopedic Association scores were also excellent postoperatively for all studies reporting, with higher scores among centralized lesions vs. lateral.
Following OAT for capitellar OCD lesions, RTS rates are high; however, athletes should be counseled on the potential of a return to lower performance or the need to change positions. Lateral lesion location may negatively impact outcomes. PRO scores are typically excellent and postoperative ROM consistently improves. This information helps counsel patients regarding expectations and outcomes of OAT for OCD of the capitellum.
肱骨小头剥脱性骨软骨炎（OCD）病变在运动员中很常见。自体骨软骨移植（OAT）是一种可能的治疗选择，不过包括恢复运动（RTS）数据在内的结果仅限于小样本系列研究。本研究的目的是系统回顾OAT治疗肱骨小头OCD病变后的RTS情况。我们的次要目标是评估患者报告的结局（PROs）、活动范围（ROM）以及OAT后的并发症。
在PubMed、Embase和护理及联合健康文献累积索引中检索关于“自体骨软骨移植”及肱骨小头OCD病变相关术语的同行评议文章。如果文章报告了RTS率且随访时间点至少为12个月，则纳入研究。提取关于RTS率、PRO测量、并发症和ROM的数据。使用非随机研究方法学指数标准评估文章的方法学质量。
共检索到666篇文章，24篇文章（470例患者）符合纳入标准。总体而言，470例接受OAT治疗OCD的患者中有454例（97%）恢复了运动。RTS率在79%至100%之间。恢复到之前运动水平的比例在10%至100%之间。最常报告的是Timmerman-Andrews术后评分（范围 = 169 - 193），87%的患者评分处于优秀范围。对于所有报告的研究，术后手臂、肩部和手部功能障碍评分以及日本骨科协会评分也都很优秀，中央病变患者的评分高于外侧病变患者。
OAT治疗肱骨小头OCD病变后，RTS率较高；然而，应告知运动员恢复到较低运动水平的可能性或改变位置的必要性。外侧病变位置可能对结果产生负面影响。PRO评分通常优秀，术后ROM持续改善。这些信息有助于向患者提供关于OAT治疗肱骨小头OCD的预期和结果的咨询。
