Concomitant osteochondritis dissecans of the capitellum and radial head: kissing osteochondritis dissecans of the radiocapitellar joint.

Abstract

There are no reports addressing the treatment and outcomes of kissing osteochondritis dissecans (OCD) of the radiocapitellar joint. This study aimed to retrospectively investigate the outcomes of the surgical treatment for kissing OCD of the radiocapitellar joint. Of the 220 patients who underwent surgery for capitellar OCD, we selected those with an additional diagnosis of concomitant OCD in the radial head. Only five patients (2.3%) met the inclusion criteria. All of the patients were boys belonging to sports clubs: four played baseball and one did gymnastics. Their primary complaint was elbow pain. The mean range of motion of the elbow was -22 degrees of extension and 129 degrees of flexion. Three-dimensional computed tomography revealed a mean maximum width of 14.4 mm for the capitellar lesion and 9.8 mm for the radial head lesion. Three patients had multiple loose fragments. Five patients underwent surgery at a mean age of 12.8 years. Cases 1 and 2 underwent osteochondral autologous transplantation (OAT) for the capitellum, and the stable radial head lesions were left in place. Case 3 underwent arthroscopic fragment removal (AR) alone. Case 4 underwent OAT for the capitellum and AR for the radial head. Case 5 underwent OAT for both kissing lesions. The donor site was the nonweight-bearing articular surface of the lateral femoral condyle. The mean observation period was 5.2 years. We examined the outcomes retrospectively. Defect enlargement in the radiocapitellar joint was observed in two patients (cases 3 and 4) who did not undergo OAT for both osteochondral defects following fragment removal. These two patients required salvage OAT for both osteochondral lesions. All five patients, including the aforementioned two, returned to competitive sports. At the final follow-up, the mean postoperative self-assessment scores were six points for the DASH Sports questionnaire and nine points for the PREE. The mean range of motion of the elbow was -12 degrees of extension and 132 degrees of flexion. The mean grip strength ratio of the affected hand compared to the unaffected hand was 93.9%. Kissing osteochondral defects may tend to enlarge. This series suggests that articular reconstruction of both the capitellum and radial head is an effective treatment for kissing osteochondral defects, but more work would be needed. This is the first report addressing the treatment and outcomes of kissing OCD of the radiocapitellar joint.