Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.
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机译：目的：虽然存在许多研究，用于评估对Capitellum关节镜检查的关节镜检查的患者的短期临床结果，文献中的临床结果是单个机构的相对较多的患者的患者的长期临床结果是有限的。我们对从2001年1月至2018年8月至8月到2018年8月的Capitellum of Capitellum ocd治疗的所有患者进行了回顾性分析。我们的假设是对Capitellum的关节诊断治疗的患者的临床结果是有利的，具有改善的主观疼痛分数和可接受的回报这些患者。方法：本研究的纳入标准包括诊断和手术治疗Capitellum的Capitellum诊断和手术治疗关节性诊断，随着2年的跟进。排除标准包括在我们机构的第一次肘关节镜检查之前的Ipsilidal弯头上的任何手术治疗，丢失的操作报告和/或正在开放的关节镜程序的任何部分。使用三个调查问卷：美国肩膀和肘部外科医生，肘部（ASES-e），安德鲁斯/卡森·克尔，以及我们的机构特定的回归问卷调查问卷，通过电话通过电话进行后续行动。结果：将包含和排除标准应用于我们的外科数据库后，我们的机构确定了有资格参加本研究的101名患者。在这些患者中，然后排除3例，以留出不完全的手术报告，留下98名患者。在那些98名患者中，81例通过电话成功联系了82.7％的后续率。在关节镜检查的这个群体的平均年龄为15.2岁，随访的平均手术后时间是8.2岁。在81例患者中，74例磨损软骨成形术（91.4％），而另外7例患有轻微的清创（8.6％）。在74个磨损软骨塑化体中，其中29种具有微折衷，（39.2％的亚组和35.8％的整个包含组）。在微折衷组中，4还具有外部，髂骨嵴，间充质茎细胞注射到肘部（13.7％的Capitellar Microfracture，5.4％的磨损组合体，以及总体夹杂物组的4.9％）。额外的关节镜手术包括骨赘清创，轻微的胶质切除术，囊状释放，麻醉下的操纵和光谱。九个患者随后的修正关节镜检查（11.1％的失败率，其中5个是我们的机构，其中4个是其他地方）。含有3名患者在含有尺侧韧带重建/维修（3.7％，其中1人在我们的机构完成，另外2位）。最后，3名患者对同侧肢体的肩部作业（3.7％，在我们的机构完成的3.7％，另外2个地方）。为了控制混淆变量，仅针对关节镜检查（66名患者）没有其他手术患者的患者评估问卷的评分。该集团的平均随访7 7.9岁。对于ASES-E问卷调查问卷，右侧和左侧的ASES-E函数分数的平均值的差异最多为0.87次，最大疼痛的平均值为2.37的最大疼痛量表50和手术满意度平均为9.5分.100的平均Andrews / Carson评分为91.5，平均KJOC得分为90.5分，满分为100.另外，在64名评估的患者中，他当时参加了64名患者。他们的关节镜检查，由于肘部的局限性，3减少了运动参与。结论：总之，本研究表明，具有11.1％的关节镜检查了Capitellum关节镜后的11.1％的失效率和相当的主观性长期调查结果。需要进一步的统计分析来进行额外的比较，包括在关节镜期间不同运动之间的不同运动之间的结果比较，以及在损伤的尺寸的程度，除去的宽松的数量或其他相关的合并症影响长期临床结果。
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