I'd like to thank my co-authors, both societies as well as the Academy, for the opportunity to present this work. Our disclosures can be found in the MyAcademy app. Capitella osteochondritis dissecans is a condition resulting from localized disruption subchondral bone and articular cartilage that is typically seen in adolescent overhead throwers and gymnasts. There is a paucity of literature examining long-term outcomes of both non-operative and surgical treatment. Furthermore, factors predictive of failure of non-operative management have not been fully elucidated. Therefore, the objectives of this study were to 1. Report long-term outcomes of operative and non-operative management. 2. Identify factors associated with the failure of non-operative management. And 3. Determine if a delay in surgery affects final outcomes. All patients less than 24 years old with capitella OCD over a 25-year period were retrospectively identified. This was done utilizing a geographic cohort from the Rochester Epidemiology Project. This is a medical record linkage system that pools medical record data from medical facilities within Minnesota and Wisconsin. 50 elbows with a mean follow-up of 10.5 years were identified. 90% were athletes. The cohort was divided into three groups for analysis. 27 elbows underwent surgical intervention within six months of symptom onset. 16 elbows trialed at least six months of non-operative management prior to surgical intervention. And seven elbows underwent definitive non-operative management. In total, therefore, 70% of elbows failed their initial trial of non-operative management and eventually underwent surgical intervention. The majority of surgical patients underwent arthroscopic procedures with only 21% having an open component to their operation. The most common surgical procedures were lesion debridement with or without loose body and microfracture, or loose body removal, excuse me, and microfracture. 26% underwent fragment fixation and 12% received an osteochondral allograft or graft. To compare clinical outcomes at final follow-up, the definitive non-operative cohort and all elbows who underwent surgery were compared. Surgical management resulted in superior male elbow complexity. Surgical management resulted in superior male elbow performance index pain scores, decreased mechanical symptoms, and better mean elbow flexion at long-term follow-up. There was not. a significant difference between these two groups in return to support rates or development of elbow osteoarthritis. To determine factors predictive of failure of nonoperative management, the definitive nonoperative cohort and all elbows who underwent delayed surgery were compared. Younger age trended towards success and the presence of a loose body predicted failure with an odds ratio of 13. 11 elbows in the delayed surgery cohort had intraarticular loose bodies identified at the time of surgery. Preoperative x-ray and MRI had low sensitivity for detecting these loose bodies. Preoperative CT, however, identified the loose bodies in six of seven elbows for a sensitivity of 86%. Sex, arm dominance, lesion characteristics, and the presence of an open physis did not predict failure of nonoperative management. To determine if a delay in surgery affects final outcomes, the early surgery and delayed surgery cohorts were compared. The mean time from presentation to surgery in the delayed group was 73 weeks. There was no significant differences found between these two groups. The limitations of this study include its retrospective nature. Capillary OCD was uncommon in the study population, which led to a limited sample size. There were likely several asymptomatic or minimally symptomatic patients with capillary OCD that were never formally diagnosed or included in this study. Finally, limited radiographic follow-up greater than one year made it difficult to assess prevalence of degenerative change, including differences in between groups. In conclusion, nonoperative management of capillary OCD failed 70% of the time. Patients treated surgically had less pain, better motion, and fewer mechanical symptoms compared to those treated without surgery. The greatest predictors of failure of nonoperative management were older age and the presence of a loose body. This study did not reveal an association between a delay to surgery and long-term outcomes. Thank you.

Capitella osteochondritis dissecans

adolescent overhead throwers

gymnasts

operative management

non-operative management