Arthroscopic debridement of the humeral capitellum for osteochondritis dissecans: radiographic and clinical outcomes.
ABSTRACT Although arthroscopic debridement of the humeral capitellum is an accepted procedure for osteochondritis dissecans, some patients develop radial head enlargement or osteoarthritic lesions after the procedure. The aim of this study was to investigate the radiographic and clinical outcomes of arthroscopic debridement and consider its indications.
We retrospectively evaluated 106 patients who had arthroscopic debridement between 1997 and 2007. Surgery was performed after closure of the capitellar physis. We categorized the patients into 4 groups by lesion size and by whether the proximal radial physis was open or closed. The average patient age at surgery was 15 years (range, 12-18 y), and the average follow-up period was 13 months (range, 8-46 mo).
In patients with large lesions and open proximal radial physes, radiographic and clinical outcomes were poor. Three of 4 patients developed early osteoarthritic lesions of the radiohumeral joint, secondary to radial head enlargement. Radial head resection was required in 2 of 3 patients. Conversely, osteoarthritic lesions did not occur, and we observed noteworthy improvement in elbow pain routinely after the procedure in the other 3 groups. For range of motion, clinically important changes were not observed. Overall, postoperative elbow pain was absent in 89 patients. Mild pain was present in 15 patients and moderate or severe pain in 2 patients. A total of 90 patients returned to sports at pre-injury levels. Time of return to sports varied from 1 month to 5 months (mean, 2.4 mo).
Arthroscopic debridement of the capitellum can provide excellent short-term results for the treatment of osteochondritis dissecans. However, it is contraindicated in cases with large lesions when the proximal radial physis remains open.