OCD of the capitellum affects young athletes involved in elbow bearing activities. Unstable lesions are best managed surgically, although debate remains regarding the optimal method. Arthroscopic treatment allows rapid recovery, but the effect on the articular surface is undetermined. The purpose of the present study is to evaluate the outcome of arthroscopic OCD fragment excision and capitellar microfracture using functional assessment scores and repeat imaging.
We reviewed records of 13 consecutive patients with OCD lesions of the capitellum managed with arthroscopic microfracture. The mean age at the time of surgery was 17.1 years (10.9-26.8); 6 patients were skeletally immature and 5 were skeletally mature. Pre- and post-operative functional assessment included active range of motion, Mayo Elbow Performance Score (MEPS), and Timmerman/Andrews Elbow Score. All patients underwent plain radiographic and MRI evaluation at latest follow-up (minimum 12 months).
The mean range of motion improved in both flexion (133.3° -> 138.6°, p=0.067) and extension (19° -> 0.8°, p= <0.01). The mean MEPS (70.9 -> 94.5, p= <0.01) and Timmerman/Andrews Elbow scores (116.4 -> 190, p= <0.01) improved significantly. Plain radiographs demonstrated degenerative changes in 1/11 (9%). MRI evaluation demonstrated an improvement in overall joint congruence and the formation of a reparative articular surface in 8/11 (73%). No reoperations or major complications were encountered.
Arthroscopic OCD fragment excision and capitellar microfracture demonstrates good to excellent functional results in short term follow up. Follow up MRI suggests potential for a reparative fibrocartilaginous articular surface. Longer term follow-up is necessary to determine durability of the technique.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.