P011 - Osteochondritis Dissecans of the Humeral Capitellum: Updated Classification Based on Lesion Location
Abstract
Purpose
To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum versus those that are located more centrally. As a result of this review, an updated novel classification system postulated for wide-spread use.
Methods and Materials
All studies from the past 20 years, including additional updated assessments, were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum.
Results
Seven studies met the inclusion criteria. Autograft reconstruction was shown to yield favorable outcomes regardless of lesion location, as 93% (69/74) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, whereas 96% (64/66) of central lesions had excellent or good outcomes. A trend of improved outcomes for lateral lesions was seen when more aggressive surgical management was utilized, particularly when involving the lateral cartilage margin. Nonreconstructive operative management for lateral lesions showed a significant failure rate as did peg fixation of lateral lesions which was seen as high as 44% (4/9) in one of the studies.
Conclusion
Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, continue to be limited. The literature suggests that lesions located on the lateral capitellum—particularly those involving the lateral cartilage margin—require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location and size as factors influencing surgical decision making.
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