Sagittal computed tomography evaluation of osteochondritis dissecans of the capitellum correlates with clinical outcomes of arthroscopic debridement in adolescent baseball players

Objectives

To investigate the relationship between the size and location of osteochondral defects in capitellar osteochondritis dissecans (OCD) measured on coronal and sagittal reconstructed computed tomography (CT) images and the clinical outcomes of arthroscopic debridement in adolescent baseball players.

Methods

This retrospective study investigated the clinical outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players with ≥24 months of follow-up after surgery between 2008 and 2020. On preoperative coronal CT images, medial and lateral distance (%) were used to evaluate the location of the defect. Defect size (%) was also evaluated. On preoperative sagittal CT images, superior and inferior angles (deg) were used to evaluate the location of the defect. The size of the defect was evaluated using the defect angle (deg). Outcome measures were determined using the Timmerman–Andrews score at the latest follow-up. Spearman’s rank correlation coefficient was used to examine relationships between these parameters and the Timmerman–Andrews score. Statistical significance was set at p ​< ​0.05.

Results

Thirty players [mean age, 14 (range, 11–16) years] underwent arthroscopic debridement: 5 were pitchers, 7 were catchers, 13 were infielders, and 5 were outfielders. Mean follow-up duration was 26 (range, 24–66) months. The median Timmerman–Andrews score at the latest follow-up was 193 [interquartile range (IQR), 181–200] points. Inferior angle showed statistically significant positive correlations with Timmerman–Andrews score (r_s ​= ​0.520, p ​< ​0.01), pain (r_s ​= ​0.478, p ​< ​0.01), and sagittal arc of motion (r_s ​= ​0.409, p ​= ​0.025). Defect angle showed statistically significant negative correlations with Timmerman–Andrews score (r_s ​= ​−0.462, p ​= ​0.010) and flexion contracture (r_s ​= ​-0.424, p ​= ​0.020). Medial distance, lateral distance, defect size, and superior angle were not correlated with the Timmerman–Andrews score or any of its subscores.

Conclusion

Posterior or large osteochondral defects of the humeral capitellum on preoperative sagittal CT images affected the outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players.

Level of evidence

Level V, case series.