Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate Acid thread pins for treating elbow osteochondritis dissecans.
BACKGROUND
Various procedures, such as arthroscopic debridement, osteochondral transplantation, and bone plug fixation, have been described for the treatment of osteochondritis dissecans (OCD) of the humeral capitellum. However, the use of hydroxyapatite/poly-L-lactate acid (HA/PLLA) thread pins to fix the osteochondral fragment in an OCD lesion is a recent development.


OBJECTIVE
Adolescent throwing athletes would return to preinjury levels of function after arthroscopic osteochondral fragment fixation using HA/PLLA thread pins.


METHODS
Case series; Level of evidence, 4.


METHODS
Enrolled in this prospective cohort study were 18 adolescent baseball players (mean age, 14.2 years; range 12-16, years) with elbow OCD who underwent arthroscopic fragment fixation with HA/PLLA thread pins between 2006 and 2009. All patients were affected on their dominant side. Plain radiographs taken before surgery showed an open physis in 13 patients (72%) and a closed physis in 5 patients (28%). During surgery, the condition of the OCD lesion was evaluated by use of the International Cartilage Research Society (ICRS) classification system; there were 5 grade II, 11 grade III, and 2 grade IV cases. Outcomes were assessed after 3 years (mean, 39 months; range, 36-50 months). Elbow function was measured using the Timmerman and Andrews score and the Mayo Elbow Performance Index. Return to sports activity was assessed as higher than preinjury, same level, lower level, or no return to sports.


RESULTS
The mean Timmerman and Andrews score improved significantly from 126.6±6.5 to 197.5±1.5, and the mean Mayo Elbow Performance Index improved significantly from 68.0±2.1 to 98.06±0.9 (P=.0001 for both). Mean elbow extension improved significantly from -10°±10.4° to -0.8°±5.2° (P=.006), and mean flexion improved significantly from 123.1°±17.9° to 138.6°±6.1° (P=.001). Three patients had a loss of extension greater than 5°. Five patients returned to a higher level of sports activity, 10 patients returned to the same level, and 2 patients returned to a lower level. A remaining patient did not return to baseball. In one patient, the lesion did not heal, resulting in fragmentation at 1 year after surgery. This patient consequently underwent revision arthroscopy to remove the lesion, and he eventually returned to sports at the same level of activity.


CONCLUSIONS
Arthroscopic fragment fixation using HA/PLLA thread pins provides a beneficial clinical outcome to adolescent baseball players with humeral capitellar OCD.
Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan soushi@med.uoeh-u.ac.jp.
Soshi
S
Uchida
Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.
Hajime
H
Utsunomiya
Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.
Tomonori
T
Taketa
Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.
Shinsuke
S
Sakoda
Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Akihisa
A
Hatakeyama
Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Toshitaka
T
Nakamura
Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Akinori
A
Sakai
D000293:Adolescent; D001182:Arthroscopy / Q000379:methods*; D001484:Baseball / Q000293:injuries*; D001858:Bone Nails; D002648:Child; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D017886:Durapatite / Q000737:chemistry; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000601:surgery; D019344:Lactic Acid / Q000737:chemistry; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010008:Osteochondritis Dissecans / Q000601:surgery*; D011091:Polyesters; D011108:Polymers / Q000737:chemistry; D011446:Prospective Studies; D016059:Range of Motion, Articular
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D017886:Durapatite
arthroscopic fragment fixation; elbow arthroscopy; osteochondritis dissecans (OCD)