肘関節離断性骨軟骨炎：現在の診断と管理

Osteochondritis dissecans (OCD) of the elbow occurs mainly in adolescents and young adults. It can be debilitating and difficult to manage. It occurs frequently in the capitellum of athletes who experience repetitive stress on the elbow, such as gymnasts and overhead throwers. OCD of the elbow produces insidious pain that can be deep and difficult to localize. Patients with free floating cartilage experience catching or locking sensation in the elbow throughout range of motion. Lesions can be characterized as stable, partially detached, or completely detached (fragmentation with free bodies in the elbow). Evaluation of these OCD lesions includes radiography, ultrasonography, CT, and magnetic resonance imaging. Nonsurgical treatment of OCD lesions is commonly used for stable lesions, with protective weight bearing or complete immobilization for at least 4 weeks and progression to full activity over 6 months. Recently, casting with immobilization has shown to be effective in the management of stable lesions. Surgical management is indicated for lesions that are unstable, produce mechanical symptoms, or have failed nonsurgical treatment. Surgery includes arthroscopic and open procedures such as microfracture, fragment removal, autologous chondrocyte implantation, osteochondral autograft transplantation (OAT), wedge osteotomy, osteochondral allograft, and ultrapurified alginate gel with grafting.