Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Osteochondritis Dissecans (Loose Bone Cartilage)

In throwing movements the lateral part of the elbow joint is exposed to considerable loads, because of compression due to valgus loads. This can cause the convex upper articular surface of the radius in the
forearm to come into violent contact with, and even to injure, the lateral outer portion of the articular surface of the humerus at the elbow. Cartilage from the articular surface, together with a fragment of the underlying bone, may become detached and form a loose body in the joint. Osteochondritis dissecans (loose bone cartilage) occurs most commonly in teenage boys.

Symptoms and diagnosis

– Pain is felt in the upper outer aspect of the elbow, triggered mainly by throwing movements.
– Difficulties in straightening and bending the elbow joint are experienced.
– Locking of the joint occurs during elbow movements. The loose body prevents completion of the intended movement, and such an occurrence is always painful. Muscle cramp and swelling follow.
– Swelling develops around the elbow.
– Tenderness can be felt, mainly on the outer aspect of the elbow joint.
– Both elbow joints should be X-rayed, especially when the injured person is young and still growing. On the X-ray of the injured elbow joint the osteochondritis, the defect, or loose bodies (calcifications) can be seen.
– MRI or arthroscopy will confirm the diagnosis.

Treatment

The doctor may:

– prescribe rest along with muscle strength training;

– immobilize with a brace and no sports activities for 3–4 months in juvenile athletes;

– operate in symptomatic cases where conservative treatment has failed:

• in acute cases with a loose fragment or partly avulsed fragment, especially in a juvenile athlete, fix the fragment using resorbable pins or screws;

• remove all loose bodies;

• in small defects try drilling, microfracturing and abrasion or osteochondral cylinder grafts;

• in both small and large defects try autologous chondrocyte transplantation or other appropriate
techniques.

Healing

The injured athlete can usually resume sporting activity 2–3 months after surgery.

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