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Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts

BACKGROUND: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However,...

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Autores principales: Kajiyama, Shiro, Muroi, Satoshi, Sugaya, Hiroyuki, Takahashi, Norimasa, Matsuki, Keisuke, Kawai, Nobuaki, Osaki, Makoto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
72
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347432/
https://www.ncbi.nlm.nih.gov/pubmed/28321431
http://dx.doi.org/10.1177/2325967117692513
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author Kajiyama, Shiro
Muroi, Satoshi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuke
Kawai, Nobuaki
Osaki, Makoto
author_facet Kajiyama, Shiro
Muroi, Satoshi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuke
Kawai, Nobuaki
Osaki, Makoto
author_sort Kajiyama, Shiro
collection PubMed
description BACKGROUND: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts. PURPOSE: To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed. RESULTS: The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts (P < .01). CONCLUSION: Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD.
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spelling pubmed-53474322017-03-20 Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts Kajiyama, Shiro Muroi, Satoshi Sugaya, Hiroyuki Takahashi, Norimasa Matsuki, Keisuke Kawai, Nobuaki Osaki, Makoto Orthop J Sports Med 72 BACKGROUND: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts. PURPOSE: To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed. RESULTS: The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts (P < .01). CONCLUSION: Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD. SAGE Publications 2017-03-01 /pmc/articles/PMC5347432/ /pubmed/28321431 http://dx.doi.org/10.1177/2325967117692513 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle 72
Kajiyama, Shiro
Muroi, Satoshi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuke
Kawai, Nobuaki
Osaki, Makoto
Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title_full Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title_fullStr Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title_full_unstemmed Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title_short Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts
title_sort osteochondritis dissecans of the humeral capitellum in young athletes: comparison between baseball players and gymnasts
topic 72
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347432/
https://www.ncbi.nlm.nih.gov/pubmed/28321431
http://dx.doi.org/10.1177/2325967117692513
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