Thank you for the introduction and thank you for the opportunity to present today. Also thanks to my co-authors for all their hard work that went into this. So changing gears to osteochondritis dissecans, OCD, the Kapitom, it's an idiopathic problem that affects the subchondral bone. The prevalence is thought to be somewhere between one and three percent in adolescent overhead athletes, and it's thought that repetitive mechanical trauma and microtrauma and progressive vascular insult likely contributes to injury in this patient population. The current literature shows multiple surgical options in terms of treating these once we get to surgery, including debridement, drilling, microfracture, autograft, allograft, and even cartilage repair, but there's limited return to sport data currently out there, and potentially more importantly for our study, there's even less information regarding clinical outcome measures specific for overhead athletes, including patient-reported outcomes and satisfaction rates. So the purpose for our study was in adolescent baseball players following arthroscopic treatment of capitular OCD to determine the return to sport rate and return to sport time, overhead athletes-specific patient-reported outcomes, and satisfaction rates. So we obtained IRB approval. We included baseball athletes from age 10 to 19 over this eight-year window with a minimum of a two-year follow-up. We sent out surveys to these patients, including the KJOC survey, as well as the male elbow performance score, and our custom return-to-play questionnaire. Our cohort ended up being 20 patients, which were all male, all pitchers, with an average age of 15.8, with a symptom duration with nonoperative treatment of about a year and a half, and our treatments were all arthroscopic treatments, 17 debridements with some sort of marrow stimulation, and three debridements with loose body removal without marrow stimulation. Sixteen patients, or 80%, responded to the surveys with an average follow-up of 5.7 years. Return-to-sport time was 5.2 months, and return-to-sport rate was 81.3%. Nine of these patients returned to sport at the same level, and four actually returned and progressed to a subsequent level. And importantly, too, the reason for the patients who did not return to return, they said that it was actually their elbow was the reason for them stopping play. Patient-reported outcomes, so KJOC scores were low, at around 65 overall, 69 in our return-to-sport group, MEPS was 90, and 90.8 in those two groups. There were no differences in patient-reported outcomes based on duration of preoperative symptoms, lesion size or lesion location, surgery type, or age, and there were no differences in patient-reported outcomes by return-to-sport status. Overall satisfaction rate was 86%. That's long-term satisfaction, or medium-to-long-term satisfaction at that five- to six-year window when we sent them their surveys. We did have complications in 10%, one of which had some stiffness and required a contracture release, another that underwent a microfracture, and then subsequently an osteochondroallograft at 11 months postoperatively. Our return-to-sport rate that we found was within range from the other studies that are currently out there in all sport athletes. When we look at baseball specifically, typically the return-to-sport rate is somewhere around 80% to 85%, so we fell within range there, too. Also return-to-sport time at around five to six months was also within what the current literature states, but the novel aspect of our study is really reporting on these low KJOC scores, 64 in average for the entire cohort. We've seen with other studies that the KJOC scores can potentially be lower, at least lower than 100, in our elite-level athletes, our professional athletes, where 92 to 97 can be normal, potentially a little bit lower in pitchers, and then as these players get injured and undergo subsequent surgeries, the numbers can be even lower than that. So 85 after Tommy John, 82 after capotellar OCA, and 79 after slap repair, and so our number here just helps further delineate the literature. There were limitations to our study, it was retrospective in nature, so of course recall bias was potential and likely included. We didn't have any preoperative patient-reported outcomes that were collected, so unable to comment on pre- versus post-op. We have small sample size, and return to prior performance is unknown. We did not evaluate performance before or after the surgery, however with the return to sport and advancement statistics that I showed you earlier, we do gain some information there regarding that. In conclusion, in adolescent baseball players following arthroscopic treatment of capotellar OCDs, there's an 81% return to sport rate at 5.2 months, KJOC scores are low, however long-term satisfaction is high in these patients. Thank you. Great, thank you Robert. Please have a seat.

osteochondritis dissecans

subchondral bone

adolescent overhead athletes

surgical options

return to sport