Background:Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results.Purpose:To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement.Study Design:Cohort study; Level of evidence, 3.Methods:Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes.Results:A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures.Conclusion:Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

中文翻译：

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剥脱性头骨软骨炎的治疗和早期结局


背景： 肱骨头状骨软骨炎 （OCD） 的治疗主要以碎片稳定性和关节软骨完整性为指导。对于稳定的病灶，建议进行非手术治疗，而对于不稳定的病灶和非手术治疗失败的病灶，需要手术干预。可以考虑几种手术选择，但关于特定手术技术的适应症和术后比较结果的信息有限。目的： 评估根据以软骨下骨受累为重点的决策方法治疗的肱骨 OCD 患者的手术结局。研究设计： 队列研究;证据水平， 3.方法： 在三级学术中心诊断为头状 OCD 的患者被纳入一项前瞻性纵向队列研究。在入组时收集患者信息，并根据 Nelson 分级对 OCD 病变进行分类。收集接受手术治疗的患者在术前和术后的临床和放射学数据。外科手术是根据不断发展的治疗框架进行的，该框架包括专门考虑病变遏制和软骨下骨疾病的深度。获得 Timmerman 评分以评估患者功能结局。结果： 前瞻性纳入 154 例患者，其中 19 例患有双侧疾病。平均就诊年龄为 13.7 岁;39% 是体操运动员，28.5% 是初级棒球或垒球运动员。对 145 个肘部进行了手术，包括 43 例钻孔/微骨折手术、21 例内固定和 63 例自体骨软骨移植术 （OG） 手术。 临床上，疼痛、肘部运动和机械症状有显著改善。Timmerman 评分在每种类型的外科手术后都有显着提高。共有 76% 的患者恢复了他们的主要运动。当按 Nelson 分级分层时，OG 患者的翻修手术率低于钻孔/微骨折和固定治疗的患者。此外，对于 Nelson 2 级病变，与接受其他手术治疗的患者相比，接受 OG 治疗的患者术后肘部运动明显更好，Timmerman 评分更高。结论： 使用结合病灶遏制和软骨下骨疾病深度的治疗框架，肱骨 OCD 手术提供临床、放射学和功能改善。与接受其他手术技术治疗的患者相比，接受 OG 治疗的患者可能具有更低的翻修率和更好的功能结局，即使对于较低级别的 OCD 病变，也值得考虑 OG。