Background:There may be an association between repetitive stress on the elbow and capitellar osteochondritis dissecans (COCD). The influence of activity on the characteristics or specific location of the lesion within a capitellar zone of propensity remains unclear.Purpose/Hypothesis:The purpose of this study was to evaluate COCD in gymnasts and baseball players compared with a non–upper extremity (non-UE) sport COCD cohort. It was hypothesized that activity would influence presentation and lesion location and characteristics.Study Design:Cross-sectional study, Level of evidence, 3.Methods:Consecutive patients presenting with COCD treated in a tertiary sports medicine practice between March 2006 and March 2021 were reviewed. Demographic and imaging lesion characteristics were recorded. The sagittal inclination angle position of the lesion center relative to the humeral shaft was recorded. Intra- and interrater reliability was confirmed (intraclass correlation coefficient, 0.808; intraclass correlation coefficient, 0.824, respectively). Participants were analyzed by activity.Results:A total of 126 elbows were identified: 68 in gymnasts, 31 in baseball players, and 27 in patients with no history of UE sports. The mean age of the participants was 12.5 years (range, 8-18 years). All (100%) unilateral cases of osteochondritis dissecans (OCD) in baseball players occurred in the dominant throwing arm, compared with less hand-dominance correlation in gymnasts (64%) and non-UE athletes (67%). Significantly, 14 of the 20 (70%) patients with bilateral OCD were gymnasts ( P = .036). In non-UE athletes, lesions occurred at a mean sagittal inclination angle of 52.7° (±13.8°), with a mean lateral containment of 4.7 (±2.1) mm. In gymnasts, lesions occurred more posteriorly at 41.2° (±14.9°), with a lateral containment of 3.6 (±1.9) mm. In baseball players, COCDs occurred at 55.1° (±11.9°), with a lateral containment of 2.5 (±1.6) mm. These more posterior lesion positions in gymnasts ( P = .001) and lesser lesion containment noted in gymnasts ( P = .015) and baseball players ( P < .001) were significant.Conclusion:Compared with COCD lesions in adolescents with no history of UE sports, gymnastics participation (impact weightbearing) correlated with a higher rate of bilateral lesion formation and a more posterior (extended) lesion position. Baseball participation (resulting in valgus shear forces in the elbow) resulted in a sagittal position similar to non-UE lesions, but more lateral and with less containment.

中文翻译：

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头状骨软骨炎剥脱性骨软骨炎：活动对倾向区域内病变位置的影响


背景： 肘部重复应力与肱头剥脱性骨软骨炎 （COCD） 之间可能存在关联。活动对丘状体倾向区内病变特征或具体位置的影响尚不清楚。目的/假设： 本研究的目的是评估体操运动员和棒球运动员的 COCD 与非上肢 （non-UE） 运动 COCD 队列的比较。据推测，活动会影响表现和病变位置和特征。研究设计： 横断面研究，证据水平，3.方法： 回顾了 2006年3月至 2021年3月在三级运动医学实践中接受治疗的连续 COCD 患者。记录人口统计学和影像学病变特征。记录病灶中心相对于肱骨干的矢状倾斜角位置。确认了评分者内和评分者间的信度 （类内相关系数，分别为 0.808;类内相关系数，0.824）。参与者按活动进行分析。结果： 共确定 126 个肘部： 体操运动员 68 个，棒球运动员 31 个，无 UE 运动史患者 27 个。参与者的平均年龄为 12.5 岁 （范围，8-18 岁）。棒球运动员剥脱性骨软骨炎 （OCD） 的所有单侧病例 （100%） 都发生在优势投掷臂，而体操运动员 （64%） 和非 UE 运动员 （67%） 的手优势相关性较低。值得注意的是，20 名双侧强迫症患者中有 14 名 （70%） 是体操运动员 （P = .036）。在非 UE 运动员中，病变发生在平均矢状倾斜角 52.7° （±13.8°） 处，平均横向遏制为 4.7 （±2.1） mm。在体操运动员中，病变发生在 41 岁时更靠后。2° （±14.9°），横向围堵为 3.6 （±1.9） 毫米。在棒球运动员中，COCD 发生在 55.1° （±11.9°） 处，横向遏制为 2.5 （±1.6） 毫米。体操运动员 （P = .001） 的这些更靠后的病变位置和体操运动员 （P =.015） 和棒球运动员 （P < .001） 的较小病变遏制是显着的。结论： 与无 UE 运动史青少年的 COCD 病变相比，体操参与 （冲击负重） 与较高的双侧病变形成率和更后 （延伸） 的病变位置相关。参加棒球比赛（导致肘部外翻剪切力）导致矢状位与非 UE 病变相似，但更外侧且遏制性更强。