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We live in a fairly rural setting. There isn't a pediatric orthopedic surgeon in our area so we are relying on the general orthopedic surgeon from the region. How do specialists in other areas treat a problem like osteochondritis dissecans of the elbow? That's what our 11-year-old son has.
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Osteochondritis dissecans (OCD) is a condition in which a piece of cartilage and the underlying bone have been damaged. In some cases, the damaged fragment separates from the bone and floats freely within the joint.
The problem can develop in the elbow as a result of trauma (injury) but more often, it occurs when there is repetitive compression of the radiocapitellar joint. Athletes affected most often include baseball pitchers, weight lifters, tennis players, cheerleaders, and female gymnasts.
The radiocapitellar joint is located where the radius (bone in the forearm) joins the bottom of the humerus (upper arm bone) to form part of the elbow joint. Osteochondritis dissecans (OCD) of the elbow doesn't occur in immature throwing athletes very often so there isn't a lot of information about it to help guide treatment.
The first step is to rest for three to six weeks. Athletes must learn how to change the way they do things or the problem will come right back. This process is called activity modification.
A physical therapist will prescribe exercises to stretch and strengthen appropriate muscles. The physician may prescribe medications such as nonsteroidal antiinflammatories (NSAIDs). There aren't enough studies to show that this is really needed or beneficial. Specific guidelines regarding dosage (how much) and duration (how long) these medications should be used are not available.
Athletes most likely to recover nicely with conservative (nonoperative) care are younger and have early (mild) disease. Patients who have completed six months of conservative care but who still have symptoms are considered candidates for surgery.
Surgery is also considered when there are fragments of cartilage and/or bone inside the joint. These are called loose bodies. Patients who have loose bodies are most likely to develop the catching and locking symptoms of the elbow reported.
What can the surgeon do for this condition? Drilling is a popular technique for lesions that are stable. Stable means there are no loose fragments or unstable bits of cartilage that could get torn off and form a loose body.
Drilling refers to the practice of putting tiny holes in the surface of the cartilage down through the layer of bone underneath the cartilage and right through to the bone marrow. Tiny drops of blood seep up from the bone into the defect and stimulate a healing response. This type of bone marrow stimulation has good short- to medium-term results. Long-term data (especially about return-to-sports status) is still needed.
When there are loose bodies or an unstable cap, the authors prefer to use debridement first, then bone marrow stimulation. Debridement involves removing any fragments and smoothing down any remaining rough edges. If the lesions are large (more than half of the cartilage in the radiocapitellar joint is damaged), then osteochondral autograft transplantation (OAT) is advised.
The OAT technique is a two-step process. First, normal, healthy plugs of articular cartilage and bone are harvested. Because the radiocapitellar joint is so small, surgeons must rely on another joint as the donor site.
Usually the femoral condyle (end of the thigh bone forming the upper half of the knee joint) is the main source of graft plugs. The plugs are then transferred to the damaged area of the elbow joint and inserted.
More studies (especially long-term studies) are clearly needed to find out what works best for each type of athlete given the location and severity of the damage done to the radiocapitellar joint.
Your orthopedic surgeon will take all of this into consideration when making a plan of care for your son. But it's always good for parents to have some information in hand when helping to guide treatment for a child with an unusual condition like this one.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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