title: Outcomes and failure factors in surgical treatment for osteochondritis dissecans of the capitellum.
abstract: BACKGROUND
  Osteochondritis dissecans (OCD) of the capitellum is an intra-articular lesion and one of the leading causes of permanent elbow disability. The treatment of advanced capitellar OCD remains challenging because of the limited potential of the articular cartilage for self-repair. The purpose of this study was to investigate the outcome of surgical treatment for OCD of the capitellum.
  
  
  METHODS
  From 2000 to 2010, 32 male patients who had advanced lesions of capitellar OCD were treated operatively. The mean age of the patients was 14.4 years at the time of surgery. Twenty-nine patients played baseball and 3 played other sports. The lesions were of the centralized type in 9 patients, the lateral type in 4 patients, and the widespread type in 19 patients. For the surgical procedure, osteochondral peg fixation was selected for 13 patients and osteochondral autograft transplantation for 19 patients. Clinical outcome was measured with the elbow rating system including range of motion, and the number of patients who returned to active sports participation within 1 year after surgery was determined.
  
  
  RESULTS
  The mean total arc of elbow motion increased from 123±17 degrees preoperatively to 132±14 degrees postoperatively. The mean clinical score improved significantly from 133±24 to 177±27. Within the first year after surgery, 81.3% of the patients returned to active sports playing. However, 4 of 8 patients (50%) in which osteochondral peg fixation was performed for lesions of the lateral widespread type required reoperation.
  
  
  CONCLUSIONS
  Our results indicate that osteochondral peg fixation and osteochondral autograft transplantation may improve elbow rating score, and may facilitate a return to active sports participation. However, osteochondral peg fixation may be insufficient for lesions of the widespread type because of their poor stability. The large lateral condyle lesions had a worse outcome, and future studies will need to develop improved treatment for these defects.
  
  
  METHODS
  Level IV (case series).
authors.affiliation: *Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University †Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kosaka
authors.forename: Junsuke
authors.initials: J
authors.lastname: Nakase
authors.forename: Ryohei
authors.initials: R
authors.lastname: Takahashi
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Toratani
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohashi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kitaoka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000473:pathology / Q000601:surgery; D001484:Baseball / Q000293:injuries; D016025:Bone Transplantation / Q000379:methods*; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery; D002648:Child; D004551:Elbow Joint / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D010008:Osteochondritis Dissecans / Q000473:pathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome