Revision rate after surgery for elbow osteochondritis dissecans: a systemic review.

BACKGROUND

Humeral capitellum osteochondritis dissecans (OCD) is a common condition among overhead throwing athletes and is typically treated surgically. While stable lesions can be treated nonoperatively, untreated unstable lesions can lead to significant elbow discomfort and impaired quality of life. This study reviews the revision rate and interval in athletes with elbow OCD following primary surgery.

METHODS

Data was extracted from PubMed, Embase, and Medline between 1990 and 2022, and two reviewers independently screened the duplicate reports of complications and revision surgeries. The Methodological Index for Nonrandomized Research score was used for risk of bias assessment. Inclusion criteria were as follows: studies in the English language, those involving humans, those reporting complications, and those performing revision surgeries following capitellar OCD surgery. Logit transformation and random effects were calculated using the Der Simonian Laired estimator, and the Shapiro-Wilk test was first performed to determine whether revision interval data followed a normal distribution. The Wilcoxon rank sum test was used for nonparametric data comparison, while Spearman's rank correlation assessed whether shorter follow-up periods underestimated the revision rate.

RESULTS

A total of 6,457 studies were identified through the initial literature search (PubMed: 1,924; Embase: 2,532; Medline: 2,001), with 4,147 duplicates removed, leaving 2,310 unique studies for screening. After applying the inclusion criteria, 20 full-text articles were selected, all of which were level IV case series with MINORS scores ranging from 7 to 14 (mean: 10.65), demonstrating moderate heterogeneity (I = 41%) and strong inter-reviewer agreement across screening phases (κ = 0.78-0.98). Twenty studies involving 477 elbows (474 athletes) were included, 55 of which underwent revision surgery. The athletes were divided into debridement, microfracture, and osteochondral grafting groups. The overall revision rate was 11.53%, and the revision rate of the three groups were 11.2%, 14.2%, and 9.19%, respectively. Eleven of the 20 studies (24 of 175 athletes underwent revision surgery) with complete data were included in interval analysis of revision surgery. The mean intervals of all participants and three groups were 25, 41.8, 10.4, and 24.2 months, respectively. Spearman's rank correlation showed no significant association between the follow-up duration and the revision rate (rho = -0.31, p = 0.18) or the revision interval (rho = 0.02, p = 0.95) in the overall cohort. Correlation coefficients across surgical subgroups also varied in direction and were not statistically significant.

CONCLUSION

Approximately 11% of patients required revision surgery following primary treatment for elbow OCD, with an average interval of 25 months. No significant association between follow-up duration and either revision rate or revision interval. Thus, further investigations, rehabilitation programs may be required to decrease this revision rate.