Osteochondral Lesions of the Elbow

Laura W. Bancroft; Christopher Pettis; Christopher Wasyliw; Laura Varich

doi:10.1055/s-0033-1360665

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2013; 17(05): 446-454
DOI: 10.1055/s-0033-1360665

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteochondral Lesions of the Elbow

Laura W. Bancroft

¹Department of Radiology, Florida Hospital, Orlando, Florida

,

Christopher Pettis

¹Department of Radiology, Florida Hospital, Orlando, Florida

,

Christopher Wasyliw

¹Department of Radiology, Florida Hospital, Orlando, Florida

,

Laura Varich

¹Department of Radiology, Florida Hospital, Orlando, Florida

› Author Affiliations

Abstract

Osteochondral lesions of the elbow are injuries that disrupt the cartilage and subjacent bone, and they most commonly involve the capitellum. The staging, prognosis, and treatment of osteochondral lesions in the elbow are based on a combination of radiographic, magnetic resonance imaging, and arthroscopic findings. Radiographic staging includes the radiolucent, separation, and free (advanced) stages. MR imaging features of instability include cysts, osteochondral fracture, T2 hyperintense rim, subchondral plate defects, and fluid-filled osteochondral defects. Finally, arthroscopic grading of osteochondral lesions increases in severity based on findings of softened cartilage, cartilage fissuring, exposed bone, loose but nondisplaced fragments, and eventually displaced fragments resulting in intra-articular bodies. This pictorial review focuses on osteochondral lesions in the capitellum and trochlea including osteochondritis dissecans, Panner disease, and acute trauma.

Keywords

osteochondral lesions - osteochondritis dissecans - elbow - MRI - CT

Full Text

References

References
1 Ruchelsman DE, Hall MP, Youm T. Osteochondritis dissecans of the capitellum: current concepts. J Am Acad Orthop Surg 2010; 18 (9) 557-567
2 Bojanić I, Ivković A, Borić I. Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts. Knee Surg Sports Traumatol Arthrosc 2006; 14 (5) 491-496
3 Patel N, Weiner SD. Osteochondritis dissecans involving the trochlea: report of two patients (three elbows) and review of the literature. J Pediatr Orthop 2002; 22 (1) 48-51
4 Yamagushi K, Sweet FA, Bindra R, Morrey BF, Gelberman R. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg [Am] 1997; 79-A: 1653-1662
5 Kusumi T, Ishibashi Y, Tsuda E , et al. Osteochondritis dissecans of the elbow: histopathological assessment of the articular cartilage and subchondral bone with emphasis on their damage and repair. Pathol Int 2006; 56 (10) 604-612
6 Baker III CL, Romeo AA, Baker Jr CL. Osteochondritis dissecans of the capitellum. Am J Sports Med 2010; 38 (9) 1917-1928
7 Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sports Med 2001; 20 (3) 565-590
8 Iwasaki N, Kato H, Ishikawa J, Masuko T, Funakoshi T, Minami A. Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes: surgical technique. J Bone Joint Surg Am 2010; 92 (Suppl 1 Pt 2): 208-216
9 Iwasaki N, Kato H, Kamishima T, Minami A. Sequential alterations in magnetic resonance imaging findings after autologous osteochondral mosaicplasty for young athletes with osteochondritis dissecans of the humeral capitellum. Am J Sports Med 2009; 37 (12) 2349-2354
10 Byrd JWT, Jones KS. Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up. Am J Sports Med 2002; 30 (4) 474-478
11 Hayter CL, Giuffre BM. Overuse and traumatic injuries of the elbow. Magn Reson Imaging Clin N Am 2009; 17 (4) 617-638 , v
12 Panner HJ. A peculiar affection of the capitellum humeri resembling Calve-Perthes disease of the hip. Acta Radiol 1927; 10: 234-242
13 Tis JE, Edmonds EW, Bastrom T, Chambers HG. Short-term results of arthroscopic treatment of osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop 2012; 32 (3) 226-231
14 Singer KM, Roy SP. Osteochondrosis of the humeral capitellum. Am J Sports Med 1984; 12 (5) 351-360
15 Wahegaonkar AL, Doi K, Hattori Y, Addosooki A. Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans. J Hand Surg Am 2007; 32 (9) 1454-1461
16 Baumgarten TE, Andrews JR, Satterwhite YE. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med 1998; 26 (4) 520-523
17 Takahara M, Ogino T, Sasaki I, Kato H, Minami A, Kaneda K. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res 1999; (363) 108-115
18 Kijowski R, Tuite MJ. Pediatric throwing injuries of the elbow. Semin Musculoskelet Radiol 2010; 14 (4) 419-429
19 Stevens KJ, McNally EG. Magnetic resonance imaging of the elbow in athletes. Clin Sports Med 2010; 29 (4) 521-553
20 Stevens KJ. Magnetic resonance imaging of the elbow. J Magn Reson Imaging 2010; 31 (5) 1036-1053
21 Takeba J, Takahashi T, Hino K, Watanabe S, Imai H, Yamamoto H. Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases. Knee Surg Sports Traumatol Arthrosc 2010; 18 (6) 831-835
22 Kijowski R, De Smet AA. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. Skeletal Radiol 2005; 34 (5) 266-271
23 Takahara M, Shundo M, Kondo M, Suzuki K, Nambu T, Ogino T. Early detection of osteochondritis dissecans of the capitellum in young baseball players. Report of three cases. J Bone Joint Surg Am 1998; 80 (6) 892-897
24 Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Surgical technique. J Bone Joint Surg Am 2008; 90 (Suppl 2 Pt 1): 47-62
25 Harada M, Takahara M, Sasaki J, Mura N, Ito T, Ogino T. Using sonography for the early detection of elbow injuries among young baseball players. AJR Am J Roentgenol 2006; 187 (6) 1436-1441
26 Delport AG, Zoga ACMR. MR and CT arthrography of the elbow. Semin Musculoskelet Radiol 2012; 16 (1) 15-26
27 Hayes CW, Daffner RH, Weissman BN , et al; Expert Panel on Musculoskeletal Imaging. American College of Radiology (ACR) Appropriateness Criteria chronic elbow pain. Reston, VA: ACR; 2011
28 Rosenberg ZS, Beltran J, Cheung YY. Pseudodefect of the capitellum: potential MR imaging pitfall. Radiology 1994; 191 (3) 821-823
29 Kijowski R, De Smet AA. MRI findings of osteochondritis dissecans of the capitellum with surgical correlation. AJR Am J Roentgenol 2005; 185 (6) 1453-1459
30 Tuite MJ, Kijowski R. Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med 2006; 25 (3) 387-408 , v
31 Nelson DW, DiPaola J, Colville M, Schmidgall J. Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 1990; 14 (5) 804-808
32 Ouellette H, Bredella M, Labis J, Palmer WE, Torriani M. MR imaging of the elbow in baseball pitchers. Skeletal Radiol 2008; 37 (2) 115-121
33 Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics 2002; 22 (5) 1223-1246
34 Trattnig S, Winalski CS, Marlovits S , et al. Magnetic resonance imaging of cartilage repair: a review. Cartilage 2011; 2: 5-26
35 Thornton R, Riley GM, Steinbach LS. Magnetic resonance imaging of sports injuries of the elbow. Top Magn Reson Imaging 2003; 14 (1) 69-86
36 Peiss J, Adam G, Casser R, Urhahn R, Günther RW. Gadopentetate-dimeglumine-enhanced MR imaging of osteonecrosis and osteochondritis dissecans of the elbow: initial experience. Skeletal Radiol 1995; 24 (1) 17-20
37 Wiesler ER, Sarlikiotis T, Rogers S, Papadonikolakis A, Poehling GG. Arthroscopic debridement for osteochondral injury of the elbow trochlea: a case report with a long-term follow-up. J Shoulder Elbow Surg 2011; 20 (2) e18-e22
38 Marshall KW, Marshall DL, Busch MT, Williams JP. Osteochondral lesions of the humeral trochlea in the young athlete. Skeletal Radiol 2009; 38 (5) 479-491
39 Smith MV, Bedi A, Chen NC. Surgical treatment for osteochondritis dissecans of the capitellum. Sports Health 2012; 4 (5) 425-432
40 Allagui M, Koubaa M, Bellaj Z , et al. Osteochondritis dissecans of the capitellum: autologous osteochondral mosaicplasty: a case report. Chir Main 2012; 31 (4) 206-209
41 Shimada K, Tanaka H, Matsumoto T , et al. Cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. J Bone Joint Surg Am 2012; 94 (11) 992-1002
42 Vogt S, Siebenlist S, Hensler D , et al. Osteochondral transplantation in the elbow leads to good clinical and radiologic long-term results: an 8- to 14-year follow-up examination. Am J Sports Med 2011; 39 (12) 2619-2625
43 de Graaff F, Krijnen MR, Poolman RW, Willems WJ. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. Arthroscopy 2011; 27 (7) 986-993
44 Jans LB, Ditchfield M, Anna G, Jaremko JL, Verstraete KL. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol 2012; 81 (6) 1306-1310
45 Ovesen J, Olsen BS, Johannsen HV. The clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum of young athletes. J Shoulder Elbow Surg 2011; 20 (5) 813-818
46 Mihara K, Suzuki K, Makiuchi D, Nishinaka N, Yamaguchi K, Tsutsui H. Surgical treatment for osteochondritis dissecans of the humeral capitellum. J Shoulder Elbow Surg 2010; 19 (1) 31-37
47 Miyamoto W, Yamamoto S, Kii R, Uchio Y. Oblique osteochondral plugs transplantation technique for osteochondritis dissecans of the elbow joint. Knee Surg Sports Traumatol Arthrosc 2009; 17 (2) 204-208
48 Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB. Osteochondral transplantation to treat osteochondral lesions in the elbow. J Bone Joint Surg Am 2007; 89 (10) 2188-2194
49 Micheli L, Curtis C, Shervin N. Articular cartilage repair in the adolescent athlete: is autologous chondrocyte implantation the answer?. Clin J Sport Med 2006; 16 (6) 465-470
50 Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up. Am J Sports Med 2006; 34 (5) 714-720
51 Tsuda E, Ishibashi Y, Sato H, Yamamoto Y, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the capitellum in nonthrowing athletes. Arthroscopy 2005; 21 (10) 1270
52 Krijnen MR, Lim L, Willems WJ. Arthroscopic treatment of osteochondritis dissecans of the capitellum: report of 5 female athletes. Arthroscopy 2003; 19 (2) 210-214
53 Nakagawa Y, Matsusue Y, Ikeda N, Asada Y, Nakamura T. Osteochondral grafting and arthroplasty for end-stage osteochondritis dissecans of the capitellum. A case report and review of the literature. Am J Sports Med 2001; 29 (5) 650-655
54 Oka Y, Ikeda M. Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib. J Bone Joint Surg Br 2001; 83 (5) 738-739
55 Bilsel K, Demirhan M, Atalar AC, Akkaya S. A new surgical technique to facilitate osteochondral autograft transfer in osteochondral defects of the capitellum: a case report. Acta Orthop Traumatol Turc 2010; 44 (1) 82-87