Osteochondral lesions of the elbow. Current treatment concepts

Background. The etiopathogenesis of osteochondral defects is still not fully understood but is probably multifactorial; however, osteochondral lesions of the elbow joint are assumed to be microtraumatic due to repetitive stress in throwing sports. Osteochondral lesions of the capitellum must be distinguished from Panner's disease. Patients with these entities complain mostly of stress-related pain during sports and movement restrictions of the joint. Methods. The diagnosis and differentiation between osteochondral lesions and Panner's disease can usually be made by clinical examination and standard X-ray analysis but should be supplemented by magnetic resonance imaging (MRI) for a more detailed classification of the lesion. A classification system for osteochondral lesions has been proposed by Nelson and Dipaola subdividing lesions into four grades. Stable lesions and patients with open growth plates are usually treated non-operatively while instable lesions should be managed surgically. Con-servative treatment mainly involves activity modification and cessation of sports activities and shows good results particularly in patients with open capitellar physes. Treatment of Panner's disease is similar to the conservative treatment of osteochondral lesions and has a good long-term prognosis. The surgical treatment options for osteochondral lesions of the elbow are numerous and include primarily arthroscopic debridement, fragment fixation and osteochondral transplantation. Osteochondral transfer replaces both the cartilage and the bone defect and allows a reconstruction of the articular surface with hyaline cartilage. Conclusions. Mid-term and long-term studies show superior clinical and radiological results of osteochondral transplantation compared to simple debridement surgery.