Return to Play Rates Following Arthroscopic Treatment of Elbow Osteochondritis Dissecans Lesions in Adolescent Baseball Players

Objectives: Osteochondritis dissecans (OCD) of the humeral capitellum is a common elbow injury in adolescent overhead throwing athletes likely secondary to the excessive valgus stress placed on the joint during the throwing motion. The purpose of this study is to retrospectively investigate the clinical findings and outcomes, including return to play rates, of overhead throwing athletes who underwent elbow arthroscopy for the treatment of osteochondral lesions of elbow. Methods: Throwing athletes who underwent elbow arthroscopy over an eight-year period, 2010 to 2018, were identified and included in our analysis. From this cohort of patients, those who were treated for OCD of the elbow joint and were baseball players were selected for analysis. Non-baseball athletes and those who underwent a concurrent procedure that required an open approach were excluded. Patients were contacted via phone to complete the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Mayo Elbow Score as well as a custom return to play and re-injury questionnaire. The minimum follow-up was 2 years from arthroscopic treatment. Results: Twenty patients met the inclusion criteria and were assessed in this analysis. All of the patients were male with an average BMI of 24.7 (range, 17.8-36.6). The average age at the time of surgery was 15.8 years old (range, 11.7-19.9). All 20 athletes played baseball pre-operatively and had no injury history or previous elbow surgery. Two patients had complications post-operatively. One patient received surgery for contracture release and debridement 7 months post-operatively. The other patient had a repeat arthroscopic microfracture procedure 4 months post-operatively followed by placement of an osteochondral allograft 11 months post-operatively for continued symptoms. Furthermore, three patients sustained an injury to the throwing shoulder or elbow after the operation. Two patients reported that the post-operative injury was throwing-related. One sustained an elbow stress fracture which was treated non-operatively while the other had a UCL reconstruction at 48 months post-operatively. The last patient reported sustaining an acromioclavicular joint separation that was treated operatively but not related to baseball or throwing. A total of 16 patients were available to complete the assessment. The average final follow-up was 5.5 (2.1-10.2) years with average KJOC of 64.6 (range, 13.9-97.0) and a Mayo Elbow Score of 90.0 (range, 60-100). Following surgery, 13/16 (81.2%) patients were able to return to their pre-injury sport and all returned to the same or higher level of competition. Seven patients reported improved symptoms, eight reported resolution of symptoms and one reported worsening of their symptoms after surgery. Overall patients were quite satisfied with their surgery, reporting an average 85.6% satisfaction rating. Conclusions: The results of this study indicate that elbow arthroscopy for osteochondral lesions in overhead throwing athletes is a reliable operation with 81.2% of athletes returning at the same or higher level of competition with low re-operation rates. In addition, these results boast a low complication rate and high patient satisfaction rate following elbow arthroscopy for OCD.

PROSPECTIVE EVALUATION OF PERIARTICULAR HYALURONIC ACID INFILTRATION FOR THE TREATMENT OF LATERAL EPICONDYLITIS

ABSTRACT Objective: To prospectively, clinically and functionally follow-up patients previously diagnosed with lateral epicondylitis after periarticular application of hyaluronic acid and analyze the results. Methods: All patients were previously treated conservatively and had no clinical improvement. Data such as age, positivity for specific tests (Cozen and Mill), visual analogue pain scale (VAS) before and during dorsiflexion of the wrist with resistance, diagnosis time, Mayo Elbow Performance Score was collected. Patients were reevaluated 30 and 90 days after application. Results: The positivity rates for Cozen and Mill tests were identical, starting at 100%, dropping to 50% after one month, and ending at 41.7% after 3 months. The initial Mayo Elbow Score average was 61.3 points; 85.8 in the first month, remaining at 85 in the third month. VAS in active force situations had the initial average of 8.1; after one month it dropped to 3.8, and 3.6 after three months. At rest, the initial average was 5.9; after one month it decreased to 3 and ended at 2.1 in three months. Conclusion: Patients showed improvement in pain parameters, in the Mayo Elbow Performance Score standard, but with 25% of failure in satisfaction. Level of evidence IV, Case series.

Functional outcome of radial head replacement in isolated radial head fractures

<p class="abstract"><strong>Background:</strong> Proximal radial fractures are common type of fracture around the elbow joint. These commonly occur after an episode of fall on the outstretched arm. These fractures can occur in isolation or with other associated injuries. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring stability of the elbow joint and starting early mobilization. This study will assess functional outcome of radial head replacement in isolated radial head fractures using Mayo elbow performance score<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Over a period of 24 months a total of 18 patients (male 12 and female 6) with isolated radial head fractures were included in the study. All of these patients had MASON type III fractures or above. Radial head replacement arthroplasty was done for irreparable radial head fractures and early mobilization was started. Functional outcome was calculated postoperatively with help of the Mayo elbow score on follow-up at 1, 3 and 6 month interval.<strong></strong></p><p class="abstract"><strong>Results:</strong> On the basis of Mayo elbow performance scores, 13 patients had excellent results; 3 had good results; and 2 had fair results. Mean Mayo elbow score was 88.33 (SD 11.11) after 6 month follow up. None of the patients had elbow instability after radial head replacement<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Treatment of irreparable radial head fractures with radial head prosthesis along with soft-tissue reconstruction shows satisfactory results. Early mobilization of the elbow after operation is the key for restoration of elbow range of motion and function<span lang="EN-IN">.</span></p>

Establishing the Role of Unlinked Total Elbow Arthroplasty in Low Demand Patients: A Long-Term Follow-up Study

<p><strong>Introduction:</strong> Experience with total elbow arthroplasty is scarce in most centers. It seems to have a significant rate of associated complications. Most studies are based on non-validated outcome measures and short-term results. <br /><strong>Material and Methods:</strong> We selected patients undergoing unlinked total elbow arthroplasty, with a resultant sample of thirteen cases, with a mean postoperative follow-up of 72 months. We applied the Mayo Elbow Score and all patients underwent an X-ray study, prior to surgery and during the follow-up period. <br /><strong>Results:</strong> All patients have a systemic inflammatory condition. The mean Mayo score increased from 43 points preoperatively to 70 and 80 points at the intermediate follow-up period (with a mean of 15 months after the operation) and at the time of the latest follow-up evaluation (with a mean of 72 months after the operation). There was an increase in range of motion in all cases. There was one case of mechanical failure and two cases of transient ulnar neuropathy. <br /><strong>Discussion:</strong> Elbow dysfunction causes great loss in patient´s quality of life, incapacitating them for the simplest activities. Small improvements in range of motion and pain relief result in significant changes in the patient’s functional ability. There is a demand to clarify the performance of total elbow arthroplasty in selected patient groups in order to throw more light on the relative roles of the available implants. <br /><strong>Conclusions:</strong> The results obtained in this study seem to confirm the long-term benefit of the unlinked arthroplasty in severe joint dysfunction in patients with low physical demand, particularly in rheumatoid arthritis, a common and limiting condition in our population.</p>