THE ARTHROSCOPIC MANAGEMENT OF OSTEOCHONDRITIS-DISSECANS OF THE ADOLESCENT ELBOW

The management of avascular necrosis of the capitellum of the adolesce nt elbow continues to be a dilemma. This article is a critical retrosp ective analysis of 12 pediatric patients (mean age at surgery 14.5 yea rs) who underwent arthroscopic debridement alone followed by early ran ge of motion. Follow-up at a mean of 3.2 years (range, 2.0 to 5.7 year s) indicated that the average flexion contracture improved from 23 deg rees preoperatively to 10 degrees postoperatively. All patients had re modeling of the capitellum by plain radiographs; however, five patient s had associated enlargement of the radial head. Eleven patients had m inimal mechanical symptoms after the procedure and were highly satisfi ed. One patient had substantial enlargement of the radial head with co ntinued loss of supination and mechanical symptoms requiring radial he ad resection 2 years after the index procedure. Five patients had a tr iangular avulsion fragment present off the lateral capsule. A statisti cally significant worse subjective outcome was associated with the pre sence of this fragment (P < .005). There were no complications.