Abstract
Objectives:
Capitellar osteochondritis dissecans (OCD) lesions occur in 2 per 100,000 persons aged 6 to 19, making it challenging for clinician scientists to study this condition. The ROCKET study group was developed to prospectively collect clinical and patient-reported data from multiple centers to comprehensively study this disease and develop evidence-based treatment algorithms. This study’s purpose was to describe lesion characteristics and treatment paths from the elbows enrolled in the ROCKET capitellar OCD prospective cohort.
Methods:
This descriptive epidemiology study queried patients prospectively enrolled from January 2016 through April 2024 by 18 surgeons from 9 institutions across the United States. Physical examination, radiographic, and initial treatment data were obtained from the baseline appointment. Descriptive statistics were completed for all outcomes of interest.
Results:
The cohort consists of 357 elbows (Right-71%) from 326 patients. On physical exam, 65.0%(n=232) had tenderness to palpation. Compared to the contralateral arm, the affected side presented with a loss of 5° extension (IQR: 0-10), and 0° degrees of flexion (IQR: -10-0).
Initial MRI evaluation revealed 22.7%(n=81) of elbows had a high signal breach, 24.1%(n-86) had high single behind the progeny, and 31.7%(n=113) had a loose body. The majority of elbows demonstrated immature or transitional physes, with just over 1/3 of the cohort fully mature at enrollment (Open-33.2%, Closing-24.3%, Closed-38.2%). Lesions sizes, on average, were 10.8±3.3mm (width) by 6.6±4.2mm (depth) on sagittal views and 10.3±3.1mm (width) by 7.1±3.0mm (depth) on coronal views. The majority of lesions were located centrally (73.7%) on sagittal view, and central (40.4%) or central/lateral (37.7%) on coronal view. Most lesions (81.4%) were contained, with some degree of lateral osteochondral margin present. A progeny was observed in 70.4%(n=235) of lesions.
Operative treatment was the initial plan of care for 74.5%(n=266) of elbows, whereas 19.9%(n=71) of elbows were treated non-operatively and the initial plan was undecided in 5.6% (n=20). Restriction of provocative activities (71.8%, n=51) was the primary non-operative treatment plan. Osteochondral grafting (44.6%, n=136) and microfracture (23.0%, n=70) were the most commonly performed surgical procedures.
Conclusions:
Similar to other pathologies, early diagnosis may improve treatment success and long-term outcomes. The majority of lesions in the cohort presented as unstable lesions leading to initial operative treatment. Future studies will look to correlate presenting signs and symptoms, radiographic findings, and demographics to improve diagnostic and treatment algorithms to reduce surgical burden and work towards ultimately preventing these lesions.