The surgical treatment aim is to resurface the osteochondral defect and restore osteochondral integrity. With respect to the patient, this will result in short-term decrease of pain, increase in range of motion, resulting in the ultimate aim to…
ID
Source
Brief title
Condition
- Joint disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
• Short term follow up
Return to sport, we defined return to sports for our patients as returning to
same pre injury type and level of sports. Pre injury and short term post injury
type of sports and level of the gymnasts will evaluated with a simple patient
survey. Furthermore, return to sport will be scored with the *return to sport*-
subscale of the MAESS. In addition, patient medical files will be retrieved to
get any additional information.
• Long term follow up
MRI is the best technique available for assessment of articular cartilage.
Imaging of regions of cartilage damage has the potential to provide morphologic
information about the region, such as fissuring, and presence of partial or
full thickness cartilage defects. Therefore MRI will be used to evaluate
development of OA.
Development of osteoarthritis (OA), will be scored as absent (grade 0) or
present (grade I-III). OA will be evaluated on MRI by the following
characteristics:
- Grade 0 lesions, defined as cartilage with a normal intrinsic signal and a
normal surface contour
- Grade I lesions, defined as having areas of inhomogeneous signal intensity.
- Grade IIa lesions, as cartilage defects that involve less than half of the
articular cartilage thickness.
- Grade IIb lesions, as cartilage defects involving more than half of the
cartilage but less than full thickness.
- Grade III lesions, as cartilage defects exposing the bone.
Secondary outcome
• Pain: will be scored as present or absent
- pre-operative (Yes / No) - retrieved from medical charts
- between 3 and 6 months after surgery - retrieved from medical charts
- > 3 years pain will be scored as present or absent. If pain is present, the
Visual Analoque Scale (VAS) will be used to determine the degree of pain.
• ROM: flexion/extension, pro and supination
- pre-operative - retrieved from medical charts
- between 3 and 6 months after surgery - retrieved from medical charts
- > 3 years after surgery - during physical examination
• Function of the elbow
Modified Andrews elbow scoring system and Mayo elbow performance score,
pre-operative - retrieved from medical charts
- between 3 and 6 months after surgery - retrieved from medical charts
- > 3 years after surgery - during physical examination
Background summary
Osteochondritis dissecans (OCD) is an avascular necrosis of the articular
cartilage and underlying subchondral bone that occurs in the capitellum. The
precise etiology of OCD of the humeral capitellum has not been universally
agreed on.
A widely believed cause is injury due to repetitive stress on the affected
bone, which explains why (young, [semi]-professional) athletes often develop
OCD of the elbow. OCD of is a career-threatening injury and in the long-term
may cause symptoms with daily activities [4]. These athletes are usually
throwers (baseball), power grippers (weight lifters and racquet athletes), or
those who use the elbow as a weight-bearing joint (gymnasts).
Of these higher level risk sport, gymnastics is the most popular sport in the
Netherlands. Therefore, most of the athletes seen with OCD of the elbow are
gymnasts.
Patients with OCD of the elbow experience a dull, poorly localized lateral
elbow pain with decreased range of motion. Late (mechanical) symptoms are
popping, locking, and catching of the joint, which may result in a temporarily
or permanent ending of sports activities in these relatively young patients.
Clinical symptoms shown on radiographs, may show different changes in a
localized area of the capitellum like a crater, flattening, and subchondral
sclerosis. Long-term complications of OCD include radial head hypertrophy,
early degenerative changes, and loss of range of motion.
The management of OCD lesions of the capitellum is controversial. Options
include conservative treatment (close observation with activity modification),
or surgical treatments (debridement, drilling or curettage, bone grafting, or
reattachment).
Study objective
The surgical treatment aim is to resurface the osteochondral defect and restore
osteochondral integrity. With respect to the patient, this will result in
short-term decrease of pain, increase in range of motion, resulting in the
ultimate aim to regain their previous sports level. Good short term results
have been described in earlier studies. A recent review has shown the
limitations of these studies, due to their low methodological quality (e.g. no
pre- and postoperative data, small patient groups) and lack of long-term follow
up [de Graaff et al]. Recently, a study, performed in 31 patients with OCD of
the elbow has showed that on the long term, these patient have an increased
risk on the development of osteoarthritis. However, more studies are needed to
confirm this.
Study design
Retrospective cohort study, performed at Onze Lieve Vrouwe Gasthuis, Dept of
Orthopaedics and Traumatology, Amsterdam, The Netherlands.
At the outpatient clinic, patients will be asked several questions with regard
to their past and current sport activities at the outpatient clinic, as well as
two questionnaires on elbow function (MEPS and MAESS), followed by a physical
examination (ROM) performed by the examiner (15 minutes). Thereafter an MRI
will be made of the elbow (30 minutes). Both the examination and the MRI will
preferably be in 1 visit.
Study burden and risks
Not applicable
Oosterpark 9
Postbus 95500, 1090 HM Amsterdam
Nederland
Oosterpark 9
Postbus 95500, 1090 HM Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
- Gymnast
- Osteochondritis dissecans
- Arthroscopic surgery
Exclusion criteria
- No informed consent
- Age < 12 years
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL34746.100.10 |