Contained versus uncontained lesions in juvenile elbow osteochondritis dissecans

Juvenile osteochondritis dissecans (OCD) of the elbow typically affects the capitellum and may be "contained" (surrounded by intact cartilage) or "uncontained" (extending beyond the lateral cartilaginous margin). The purpose of this investigation was to compare the clinical presentation, radiographic findings, and surgical results of patients with contained versus uncontained lesions.

Forty-three elbows in 42 patients who underwent surgery for OCD were followed for an average of 19.5 months. Average age at surgery was 14.2 years (range, 11.2 to 18.2 y); there were 16 female and 26 male patients. Preoperative magnetic resonance imaging was analyzed for location and size of the lesions, alignment and size of the radial head, presence of loose bodies, and lesion grades. Patients with contained and uncontained lesions were compared on the basis of preoperative characteristics, operative findings, and postoperative results.

During surgeries of the 43 elbows, 22 elbows had loose bodies, which were removed, 32 underwent drilling, and 6 lesions had internal fixation of the OCD lesion. Twenty-nine of the 43 elbows (67%) had contained lesions, and 14 (33%) were uncontained. Preoperatively, uncontained lesions had greater, but not statistically significant, flexion contractures (24.8 vs. 14.3 degrees, P=0.088), and more swelling (9/14, 64% vs. 7/29, 24%, P=0.007). There was a trend toward significance for the uncontained lesions to be larger (155 vs. 125 mm, P=0.15) and shallower (7.0 vs. 7.6 mm, P=0.07). Postoperatively, uncontained lesions again had greater flexion contracture (13.4 vs. 3.3 degrees, P=0.025).

At short-term follow-up, uncontained elbow OCD lesions have greater flexion contracture when compared with contained lesions. They also have higher rates of joint effusion and are broader and shallower than contained lesions.

Prognostic level IV.