Prevalence of Capitellar Osteochondral Abnormalities in Healthy Youth Gymnasts: An Ultrasound Study

Gymnasts, due to repetitive upper extremity weightbearing, are prone to capitellar osteochondritis dissecans (OCD) lesions, which often require surgery and result in time away from sport. Ultrasound has shown promise for detecting early, often asymptomatic, capitellar osteochondral lesions in baseball players; however, it has not been applied to young, healthy gymnasts.

To determine the prevalence and characteristics of capitellar osteochondral abnormalities in young, high-level gymnasts.

Cross-sectional study; Level of evidence, 3.

This institutional review board-approved study recruited healthy gymnasts aged 10 to 19 years from local gymnastics clubs. The exclusion criteria included treatment for an upper extremity injury within the past 6 months or previous elbow surgery. Participants completed questionnaires to capture sports history and upper extremity function through patient-reported outcomes (PROs). Physical examination assessed elbow extension, valgus alignment, and ultrasound assessed humeral retrotorsion angles. Ultrasound evaluation of the medial elbow and radiocapitellar joint was performed. Comparisons were made between gymnasts with and without capitellar osteochondral abnormalities.

A total of 62 elbows were evaluated in 31 gymnasts (13.7 ± 2.9 years; 80.6% women). They trained at levels 6 to elite (median, 8.57), with 8.9 ± 3.7 years of gymnastics participation. A total of 15 (24.2%) elbows (9 gymnasts) had radiocapitellar joint abnormalities. Also, 66.7% (n = 6) of gymnasts with radiocapitellar joint abnormalities had bilateral abnormalities. Visualized capitellar changes included 7 concavities of the subchondral plate (11.3%), 6 with subchondral flattening (9.7%), and 2 with division of the subchondral plate (3.2%). Capitellar changes were associated with pain with palpation of the radiocapitellar joint (P < .01) and dominant arm Single Assessment Numeric Evaluation Elbow Score (P = .02). Capitellar changes were not associated with other PROs (P > .05), gymnast level (P = .80), years in sport (P = .90), elbow extension (right, P = .45; left, P = .68), or valgus differences (right, P = .39; left, P = .22).

One in 4 high-level youth gymnasts demonstrated capitellar osteochondral abnormalities, often bilateral and associated with pain to palpation over the radiocapitellar joint but unrelated to function. Prospective studies are needed, but ultrasound screening may allow earlier detection of capitellar OCDs in youth gymnasts.