Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes

Sachin Allahabadi; Jessica K Bryant; Ashish Mittal; Nirav K Pandya

doi:10.1177/2325967120963054

Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes

Orthop J Sports Med. 2020 Nov 9;8(11):2325967120963054. doi: 10.1177/2325967120963054. eCollection 2020 Nov.

Authors

Sachin Allahabadi¹, Jessica K Bryant¹, Ashish Mittal², Nirav K Pandya¹

Affiliations

¹ Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
² San Francisco Orthopedic Residency Program, St Mary's Medical Center, San Francisco, California, USA.

Abstract

Background: Osteochondral injuries of the elbow are limiting and affect the ability of pediatric and adolescent athletes to participate in sports.

Purpose: To report short- and midterm outcomes on athletes undergoing microfracture or fragment fixation of osteochondral elbow lesions and evaluate the effects thereof on sporting activity.

Study design: Case series; Level of evidence, 4.

Methods: This was a retrospective study analyzing patients who underwent surgical treatment via microfracture or fragment fixation for osteochondral elbow lesions. Patients were treated at a single institution by a single surgeon between 2012 and 2019. Diagnosis was confirmed with magnetic resonance imaging, and patients were indicated for surgery after having persistent symptoms despite trialing rest, immobilization, and/or activity restriction for at least 3 months. Demographic data including sports of choice were collected preoperatively. Imaging and intraoperative findings were documented, and any complications were noted. Range of motion (ROM) was compared pre- to postoperatively. Return-to-sport evaluation included the ability to play the preoperative sport of choice.

Results: In total, 23 patients (25 elbows) were included with a mean follow-up of 23.5 months (range, 6-60.3 months) and a mean age of 13.8 years. Of 25 lesions, 20 (80%) were on the athlete's dominant side. There was significant improvement from pre- to postoperative ROM, including extension (mean ± SD, 6.4° ± 5.3° to 0.04° ± 0.2°; P < .00001), flexion (129.2° ± 10.6° to 138.6° ± 4.4°; P = .00013), and arc of ROM (122.6° ± 13.2° to 138.6° ± 4.4°; P < .00001). Mean lesion size was 81.9 ± 59.3 mm² (range, 15-225 mm²). All elbows demonstrated radiographic healing postoperatively. Mean time to release to sport was 4.48 ± 1.38 months (range, 2.5-8 months). Six (26.1%) patients changed or stopped their preoperative sporting activity, including 2 of 4 gymnasts and 4 of 11 baseball players.

Conclusion: Arthroscopic technique with lesion debridement and microfracture or fixation appears safe and results in radiographic healing; however, with these techniques, there remains a high rate of inability to return to sport in patients involved in higher-demand upper extremity activity, such as baseball and gymnastics. Further treatment strategies, including cartilage restoration procedures, may be warranted in this population.

Keywords: baseball/softball; elbow; gymnastics; osteochondral; osteochondritis dissecans; pediatric sports medicine.