Osteochondritis dissecans of the capitellum

Osteochondritis dissecans (OCD) of the capitellum is a debilitating elbow condition in adolescent athletes engaging in sporting activities such as baseball, gymnastics and tennis. Advanced imaging methods such as computed tomography (CT) and magnetic resonance (MR) imaging are of paramount importance in the (early) diagnosis of this condition. This thesis has demonstrated that state-of-the-art quantitative 3-dimensional CT and mapping technique are reliable methods in the assessment of the size and location of an OCD lesion, which are two important parameters in surgical decision making. Also, when using MR imaging for lesion assessment, relatively simple distinctions (e.g., size, location or stability) are more reliable than complicated classification systems and should therefore be used when making treatment decisions. In addition, this thesis demonstrated that arthroscopic debridement and microfracture for advanced lesions result in satisfactory clinical outcomes, especially in skeletally immature patients and in procedures including loose body removal. Osseous healing, as assessed by CT, is either good or fair in the majority of patients but is interestingly enough not related to clinical outcomes. When more invasive treatment is indicated by means of osteochondral autologous transplantation, the ipsilateral elbow may potentially be used as a donor source instead of the knee or rib of the patient. Both alternative donor sites, the non-articulating part of the radial head or olecranon tip, provide an appropriate topographic and histopathological match with the capitellum. Although many aspects of OCD of the capitellum remain unclear, this thesis provides useful recommendations for daily clinical practice and future studies