Long Term Results of Arthroscopic Debridement of Osteochondritis Dissecans in Adolescent Athletes

OBJECTIVES: Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent athletes.Treatment of the lesions is determined by the age, symptom, radiographic appearance, and whether the cartilage is intact. Surgical indications include persistent symptoms despite conservative treatment, symptomatic loose bodies, and displacement or detachment of the fragment. Both arthroscopic and open treatments have been proposed and most authors recommend initial arthroscopic treatment with conversion to arthrotomy, as needed. Surgical treatment may consist of removal of loose bodies or fragments, fragment fixation with a bone graft, and autologous osteochondral plug grafting. Arthroscopic debridement is a common and minimally invasive procedure, however, little is known about the long term outcome of arthroscopic debridement for adolescent OCD patients. The purpose of this study was to investigate minimum 10 year follow-up outcome of arthroscopic debridement of OCD in adolescent athletes. METHODS: We retrospectively evaluated 25 athletes who had arthroscopic debridement. The average age at surgery was 15.0 years (range, 13-17 years).The sport related to the onset of the symptoms was baseball for 23 patients, and basketball and kendo for 1 patient each. We conducted arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The mean follow-up was 12.7 years (range, 10-13.5 years). The assessment included elbow pain, Timmerman and Andrews (TA) scores for the subjective component, and return to sports. Preoperative radiographic lesion size was categorized according to the classification of Takahara et al. RESULTS: At final follow-up, 19 patients (76%) had no elbow pain, 5 patients (20%) had occasional mild pain, and only 1 patient (4%) had pain with moderate activity. TA scores for the subjective component was as follows; 100 points in 19patients, 95 points in 3 patients, 90 points in 2 patients, and 55 points in 1 patient. The evaluation result was excellent in 24 patients (96%) and poor in 1 patient (4%). Of all the patients, 22 patients (88%) returned to a competitive level at which they had previously played. Two patients chose another sport, and 1 patient retired from sport activity (Table 1). TA scores were associated with pain and preoperative radiographic osteochondral defects. The prevalence of elbow pain was 0% in small defect, 20% in moderate defect, and 69.2% in large defect. CONCLUSION: Long term results suggest that arthroscopic debridement of OCD for small osteochondral defects leads to excellent results and allow a return to the previous sport level.