title: Results of Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players.
abstract: Bone peg grafting (BPG) has been advocated for early-stage humeral capitellar osteochondritis dissecans (COCD). However, the clinical and radiological results of BPG, along with its indications, have not been described in detail.
  
  
  
  COCD classified as International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) I or II in adolescent baseball players can be treated successfully by BPG.
  
  
  
  Case series; Level of evidence, 4 METHODS: Eleven male baseball players (age range at surgery, 13-16 years) who underwent BPG for COCD were enrolled in this study. No improvement had been seen in any patient after 6 months of preoperative nonthrowing observation. During surgery, 2 to 5 bone pegs were inserted into the COCD lesion after confirmation of lesion stability to the bony floor. All patients were directly evaluated at 12 and 24 months after surgery by physical findings, radiological prognosis, and magnetic resonance imaging (MRI).
  
  
  
  Of the 11 patients, 10 could return to comparable baseball ability levels within 12 months. The Timmerman-Andrews score improved significantly from a mean ± SD of 171.8 ± 12.1 preoperatively to 192.3 ± 6.5 at the final observation. Radiological healing of the lesions was determined as complete in 8 patients and partial in 3. Patients possessing a centrally positioned lesion or a lesion <75% of the size of the capitellum tended most strongly to achieve complete radiological healing, while growth plate status appeared unrelated to outcome. The mean Henderson MRI score improved from 6.3 ± 1.5 to 4.8 ± 1.6 at 12 and 24 months after BPG, respectively. MRI findings also suggested that remodeling of COCD lesions had continued to up to 24 months postoperatively.
  
  
  
  BPG enabled 91% of COCD patients with ICRS OCD I or II to return to preoperative baseball abilities within 12 months. Integration of the grafted site may continue until at least 24 months postoperatively. An ICRS OCD I or II lesion with central positioning and/or occupying <75% of the size of the capitellum in the coronal plane is a good indication for BPG.
authors: Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Japan ooshiba_h@marunouchi.or.jp.
authors: Hiroyuki
authors: H
authors: Oshiba
authors: Sports Medicine Center, Aizawa Hospital, Matsumoto, Japan.
authors: Toshiro
authors: T
authors: Itsubo
authors: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Shota
authors: S
authors: Ikegami
authors: Orthopaedic Surgery, North Alps Medical Center, Azumi Hospital, Ikedamachi, Japan.
authors: Koichi
authors: K
authors: Nakamura
authors: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Shigeharu
authors: S
authors: Uchiyama
authors: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Hiroyuki
authors: H
authors: Kato
mesh_terms: D000293:Adolescent; D001178:Arthroplasty / Q000379:methods*; D001484:Baseball / Q000293:injuries*; D016025:Bone Transplantation / Q000379:methods*; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D000068958:Return to Sport; D016896:Treatment Outcome
keywords: baseball; bone peg; elbow; humeral capitellum; osteochondritis dissecans; pediatric sports medicine