ARTIGO DO MÊS (10/2009)

Nonoperative Treatment for Osteochondritis Dissecans of the Capitellum

K. Mihara, H. Tsutsui, N. Nishinaka, and K. Yamaguchi

Am. J. Sports Med., February 1, 2009; 37(2): 298 - 304.

Abstract

Background: Spontaneous healing potential and progression of osteochondritis dissecans of the capitellum have been unclear.

Hypothesis: Healing potential is high in the early stage of osteochondritis dissecans and low in the advanced stage.

Study Design Case series; Level of evidence, 4.

Methods: This retrospective study examines 39 patients with osteochondritis dissecans of the capitellum who were treated conservatively. All patients were baseball players (mean age, 12.8 years). After initial examination, all patients were advised to stop heavy use of the elbow. Physical and radiographic examinations were regularly performed and assessed. Mean duration of follow-up was 14.4 months.

Results: Early-stage lesions were present in 30 patients, while 9 patients were diagnosed with advanced lesions. Open capitellar growth plates were observed in 17 patients, and closed capitellar growth plates were seen in 22 patients. On final radiography, 25 of 30 early-stage lesions were assessed as healed. However, only 1 of 9 advanced-stage lesions was assessed as healed. The remaining 8 advanced lesions were unimproved or progressed. Healing of lesions was seen in 16 of 17 patients with an open growth plate and in 11 of 22 patients with a closed growth plate, representing a significant difference between patients with open and closed growth plates.

Conclusion:

1) Spontaneous healing potential of osteochondritis dissecans in early lesions, especially in patients with open capitellar growth plates, appears high, and nonoperative treatment is appropriate.

2) Conversely, healing potential is extremely low in advanced osteochondritis dissecans lesions.

3) Surgical intervention is recommended to achieve lesion healing in advanced cases.

Keywords: osteochondritis dissecans ; capitellum ; baseball ; adolescent

As conclusões deste estudo confirmam a necessidade de uma diagnóstico precoce, assente na análise e compreensão dos mecanismos etiológicos especificos de cada modalidade, nas suas exigências biomecânicas e numa avaliação clinica cuidadosa, para evitar lesões instáveis e extensas que exigem tratamento cirúrgico e podem deixar algumas sequelas funcionais futuras.

Raul Oliveira, Fisioterapeuta