Good afternoon. I'm Mark Rothermick from Andrews Sports Medicine and Orthopedic Center in Birmingham, Alabama. And today I'll be discussing our study looking at long-term clinical outcomes following arthroscopic treatment of OCD lesions of the capitellum. And I have nothing to disclose related to this study. So there have been many studies in the past that have looked at short-term outcomes following elbow arthroscopy for OCD lesions, typically with six-month or 12-month follow-up. These studies have generally reported acceptable outcomes with an improvement in pain and excellent return to play for athletes following this procedure. Despite these encouraging short-term outcomes, the literature is currently lacking a report regarding long-term clinical outcomes from a large cohort of patients from a single institution. So we assessed our large patient database to analyze clinical outcomes in patients treated with elbow arthroscopy for OCD of the capitellum. This database began at Andrews Sports Medicine in January of 2001 with 18 years of data to be assessed with a minimum two-year follow-up. We hypothesized that subjective clinical outcomes in these patients would also show improved pain and function scores with acceptable return to play for this cohort of patients. All of our patients had undergone elbow arthroscopy primarily to treat OCD of the capitellum with a minimum two-year follow-up. We excluded patients with prior surgery on the same elbow, an open procedure, or patients with incomplete follow-up documentation. After applying this inclusion and exclusion criteria to our large elbow database, we ended up with 107 patients available for analysis in this study. We reviewed the medical records and contacted these patients to complete several patient-reported outcome questionnaires including the ASES elbow, Andrews Carson, and ASMI return to play questionnaire. Overall we successfully contacted 90 of the 107 patients for a follow-up of 84%. These patients were then analyzed in terms of demographic and surgical data as well as their clinical outcome scores. This was a young patient population, not surprisingly, with an average age at the time of surgery of 15.2 years old. It comprised mostly young males and two-thirds were baseball players. The most common technical procedure performed at the time of surgery was debridement of the OCD lesion with abrasion chondroplasty. Other arthroscopic procedures such as microfracture, subchondral drilling, and OATS procedures were performed less commonly. Our follow-up period with these patients was long with an average of 8.3 years of follow-up. Of these 90 patients contacted for follow-up, the mean ASES pain score out of 100 was 4.0, indicating a significant decrease in pain. The ASES function score out of 36 was 34.5, indicating a high return of function. Finally, the ASES satisfaction score was 9.1 out of 10 in these patients. The Andrews-Carson score assesses limitations of daily living with a score of 0 indicating severe limitations, a score of 100 indicating no limitations. And the mean Andrews-Carson score for this cohort was 87.1. Eleven of these patients subsequently returned to the operating room for a revision procedure. In the vast majority of these, revision arthroscopies were to remove loose bodies in the elbow. Eighty-one of the 87 athletes in the cohort, or 93%, returned to their preoperative level of play. This return to play time was slightly longer for pitchers at 7.7 months versus 7.0 months for other throwing athletes and 5.4 months for non-throwing athletes. With any study looking at long-term follow-up, especially with our database spanning back 20 years, recall bias was the most significant limitation to the accuracy and subjectivity of these patient-reported outcomes. Also selection bias is possible if patients who did poorly were part of the 17 who were not reached to complete their follow-up questionnaires. But in conclusion, we found a 93% return to play rate with acceptable subjective patient-reported outcome scores and a 12% reoperation rate in this patient population. Although this is a significant contribution to what was previously not known about long-term outcomes, further statistical analysis and MRI data regarding the size and character of the lesions would improve what this adds to the literature. Our hope is that the knowledge of these long-term outcomes can be beneficial for future patients and also their medical providers to optimize surgical outcomes in the future. Thank you specifically to Eric Mussel for his work in data collection, and thank you from our team of surgeons down in Birmingham for your attention and interest in this topic. Great. Thank you very much.

Mark Rothermick

Andrews Sports Medicine and Orthopedic Center

arthroscopic treatment

OCD lesions of the capitellum

long-term clinical outcomes