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A Quantitative Analysis of Subchondral Bone Density Around Osteochondritis Dissecans Lesions of the Capitellum

Published:August 25, 2021DOI:https://doi.org/10.1016/j.jhsa.2021.06.020

      Purpose

      In capitellar osteochondritis dissecans (OCD), unstable lesions generally demonstrate signs of subchondral sclerosis. We postulate that OCD lesions have abnormal subchondral bone density. We aimed to quantify the subchondral bone thickness around OCD lesions using conventional computed tomography (CT) imaging.

      Methods

      This retrospective study included 15 patients with capitellar OCD (OCD group) and 12 patients with an unaffected radio-capitellar joint (control group). We constructed 3-dimensional humerus models using CT data and quantified the bone density with colored contour mapping to determine the subchondral bone thickness. We measured the thickness relative to the condylar height at the centroid and lateral, medial, superior, and inferior edge points of the OCD lesion, and compared the findings between the groups. We then correlated the CT measurements with the magnetic resonance imaging measurements.

      Results

      Subchondral bone thickness at the centroid and lateral, medial, superior, and inferior edges in the OCD group was significantly higher than that in the control group. Correlation analyses revealed that the magnetic resonance imaging measurements highly correlated with the CT subchondral bone measurements.

      Conclusions

      We found that there is a zone of increased subchondral bone thickness around OCD lesions that should be considered during drilling, microfracture, or other reconstruction methods. We observed a high correlation with low errors between the measurements taken from conventional CT images and the measurements from magnetic resonance imaging, suggesting that both modalities are useful in clinical decision making.

      Type of study/level of evidence

      Diagnostic IV.

      Key words

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      References

        • Iwasaki N.
        • Kato H.
        • Ishikawa J.
        • Saitoh S.
        • Minami A.
        Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients.
        Am J Sports Med. 2006; 34: 1233-1239
        • Nissen C.W.
        Osteochondritis dissecans of the elbow.
        Clin Sports Med. 2014; 33: 251-265
        • Ruch D.S.
        • Cory J.W.
        • Poehling G.G.
        The arthroscopic management of osteochondritis dissecans of the adolescent elbow.
        Arthroscopy. 1998; 14: 797-803
        • Schenck Jr., R.C.
        • Goodnight J.M.
        Osteochondritis dissecans.
        J Bone Joint Surg Am. 1996; 78: 439-456
        • Yadao M.A.
        • Field L.D.
        • Savoie III, F.H.
        Osteochondritis dissecans of the elbow.
        Instr Course Lect. 2004; 53: 599-606
        • Peterson R.K.
        • Savoie III, F.H.
        • Field L.D.
        Osteochondritis dissecans of the elbow.
        Instr Course Lect. 1999; 48: 393-398
        • Ruchelsman D.E.
        • Hall M.P.
        • Youm T.
        Osteochondritis dissecans of the capitellum: current concepts.
        J Am Acad Orthop Surg. 2010; 18: 557-567
        • Baumgarten T.E.
        • Andrews J.R.
        • Satterwhite Y.E.
        The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum.
        Am J Sports Med. 1998; 26: 520-523
        • Brownlow H.C.
        • O’Connor-Read L.M.
        • Perko M.
        Arthroscopic treatment of osteochondritis dissecans of the capitellum.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 198-202
        • Byrd J.W.
        • Jones K.S.
        Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up.
        Am J Sports Med. 2002; 30: 474-478
        • Jackson D.W.
        • Silvino N.
        • Reiman P.
        Osteochondritis in the female gymnast’s elbow.
        Arthroscopy. 1989; 5: 129-136
        • Rahusen F.T.
        • Brinkman J.M.
        • Eygendaal D.
        Results of arthroscopic debridement for osteochondritis dissecans of the elbow.
        Br J Sports Med. 2006; 40: 966-969
        • Bradley J.
        • Dandy D.J.
        Results of drilling osteochondritis dissecans before skeletal maturity.
        J Bone Joint Surg Br. 1989; 71: 642-644
        • Lewine E.B.
        • Miller P.E.
        • Micheli L.J.
        • Waters P.M.
        • Bae D.S.
        Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum.
        J Pediatr Orthop. 2016; 36: 803-809
        • Takahara M.
        • Mura N.
        • Sasaki J.
        • Harada M.
        • Ogino T.
        Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum.
        J Bone Joint Surg Am. 2007; 89: 1205-1214
        • Takahara M.
        • Ogino T.
        • Sasaki I.
        • Kato H.
        • Minami A.
        • Kaneda K.
        Long term outcome of osteochondritis dissecans of the humeral capitellum.
        Clin Orthop Relat Res. 1999; 363: 108-115
        • Bexkens R.
        • van Bergen C.J.A.
        • van den Bekerom M.P.J.
        • Kerkhoffs G.M.M.J.
        • Eygendaal D.
        Decreased defect size and partial restoration of subchondral bone on computed tomography after arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum.
        Am J Sports Med. 2018; 46: 2954-2959
        • Bexkens R.
        • van den Ende K.I.M.
        • Ogink P.T.
        • van Bergen C.J.A.
        • van den Bekerom M.P.J.
        • Eygendaal D.
        Clinical outcome after arthroscopic debridement and microfracture for osteochondritis dissecans of the capitellum.
        Am J Sports Med. 2017; 45: 2312-2318
        • Camp C.L.
        • Dines J.S.
        • Degen R.M.
        • Sinatro A.L.
        • Altchek D.W.
        Arthroscopic microfracture for osteochondritis dissecans lesions of the capitellum.
        Arthrosc Tech. 2016; 5: e477-e481
        • Oka Y.
        • Ikeda M.
        Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib.
        J Bone Joint Surg Br. 2001; 83: 738-739
        • Sato K.
        • Mio F.
        • Hosoya T.
        • Ito Y.
        Two cases with osteochondritis dissecans of the capitulum humeri treated with costal osteochondral graft transplantation.
        J Shoulder Elbow Surg. 2003; 12: 403-407
        • Shimada K.
        • Tanaka H.
        • Matsumoto T.
        • et al.
        Cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans.
        J Bone Joint Surg Am. 2012; 94: 992-1002
        • Shimada K.
        • Yoshida T.
        • Nakata K.
        • Hamada M.
        • Akita S.
        Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow.
        Clin Orthop Relat Res. 2005; 435: 140-147
        • Yamamoto Y.
        • Ishibashi Y.
        • Tsuda E.
        • Sato H.
        • Toh S.
        Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up.
        Am J Sports Med. 2006; 34: 714-720
        • Mihara K.
        • Tsutsui H.
        • Nishinaka N.
        • Yamaguchi K.
        Nonoperative treatment for osteochondritis dissecans of the capitellum.
        Am J Sports Med. 2009; 37: 298-304
        • Satake H.
        • Takahara M.
        • Harada M.
        • Maruyama M.
        Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum.
        Clin Orthop Relat Res. 2013; 471: 1137-1143
        • Itsubo T.
        • Murakami N.
        • Uemura K.
        • et al.
        Magnetic resonance imaging staging to evaluate the stability of capitellar osteochondritis dissecans lesions.
        Am J Sports Med. 2014; 42: 1972-1977
        • Iwasaki N.
        • Kamishima T.
        • Kato H.
        • Funakoshi T.
        • Minami A.
        A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes.
        Am J Sports Med. 2012; 40: 624-630
        • Case S.L.
        • Hennrikus W.L.
        Surgical treatment of displaced medial epicondyle fractures in adolescent athletes.
        Am J Sports Med. 1997; 25: 682-686
        • Gottschalk H.P.
        • Eisner E.
        • Hosalkar H.S.
        Medial epicondyle fractures in the pediatric population.
        J Am Acad Orthop Surg. 2012; 20: 223-232
        • Pathy R.
        • Dodwell E.R.
        Medial epicondyle fractures in children.
        Curr Opin Pediatr. 2015; 27: 58-66
        • Bexkens R.
        • Oosterhoff J.H.
        • Tsai T.Y.
        • et al.
        Osteochondritis dissecans of the capitellum: lesion size and pattern analysis using quantitative 3-dimensional computed tomography and mapping technique.
        J Shoulder Elbow Surg. 2017; 26: 1629-1635
        • Miyamura S.
        • Oka K.
        • Abe S.
        • et al.
        Altered bone density and stress distribution patterns in long-standing cubitus varus deformity and their effect during early osteoarthritis of the elbow.
        Osteoarthritis Cartilage. 2018; 26: 72-83
        • Johnson C.C.
        • Roberts S.
        • Mintz D.
        • Fabricant P.D.
        • Hotchkiss R.N.
        • Daluiski A.
        Location of osteochondritis dissecans lesions of the capitellum.
        J Hand Surg Am. 2018; 43 (1039.e1–e7)
        • Vezeridis A.M.
        • Bae D.S.
        Evaluation of knee donor and elbow recipient sites for osteochondral autologous transplantation surgery in capitellar osteochondritis dissecans.
        Am J Sports Med. 2016; 44: 511-520
        • Guilford J.P.
        3rd ed. Fundamental Statistics in Psychology and Education. McGraw-Hill Book Company, New York1956
        • Roberts S.
        • McCall I.W.
        • Darby A.J.
        • et al.
        Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology.
        Arthritis Res Ther. 2003; 5: R60-R73
        • Bauer M.
        • Jonsson K.
        • Josefsson P.O.
        • Lindén B.
        Osteochondritis dissecans of the elbow. A long-term follow-up study.
        Clin Orthop Relat Res. 1992; 284: 156-160
        • Aglietti P.
        • Buzzi R.
        • Bassi P.B.
        • Fioriti M.
        Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle.
        Arthroscopy. 1994; 10: 286-291
        • Ramirez A.
        • Abril J.C.
        • Chaparro M.
        Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing.
        J Pediatr Orthop. 2010; 30: 180-185
        • Logli A.L.
        • Bernard C.D.
        • O’Driscoll S.W.
        • et al.
        Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm.
        Curr Rev Musculoskelet Med. 2019; 12: 1-12
        • Bexkens R.
        • Hilgersom N.F.J.
        • Britstra R.
        • et al.
        Histologic analysis of 2 alternative donor sites of the ipsilateral elbow in the treatment of capitellar osteochondritis dissecans.
        Arthroscopy. 2019; 35: 3025-3032
        • Kock N.B.
        • Hannink G.
        • van Kampen A.
        • Verdonschot N.
        • van Susante J.L.
        • Buma P.
        Evaluation of subsidence, chondrocyte survival and graft incorporation following autologous osteochondral transplantation.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1962-1970
        • Schub D.L.
        • Frisch N.C.
        • Bachmann K.R.
        • Winalski C.
        • Saluan P.M.
        Mapping of cartilage depth in the knee and elbow for use in osteochondral autograft procedures.
        Am J Sports Med. 2013; 41: 903-907
        • van den Ende K.I.M.
        • Keijsers R.
        • van den Bekerom M.P.J.
        • Eygendaal D.
        Imaging and classification of osteochondritis dissecans of the capitellum: X-ray, magnetic resonance imaging or computed tomography?.
        Shoulder Elbow. 2019; 11: 129-136

      Reference

        • Guilford J.P.
        3rd ed. Fundamental Statistics in Psychology and Education. McGraw-Hill Book Company, New York1956