2021 ISAKOS Biennial Congress Paper
A High Rate Of Children And Adolescents Return To Sport After Surgical Treatment Of Osteochondritis Dissecans Of The Elbow: A Systematic Review And Meta-Analysis
Dan Cohen, MD, Hamilton CANADA
Jeffrey Kay, MD, Toronto, ON CANADA
Muzammil Memon, MD, Hamilton, ON CANADA
David Slawaska Eng, MD, Stoney Creek, ON CANADA
Nicole Simunovic, MSc, Hamilton, ON CANADA
Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, Hamilton, ON CANADA
McMaster University, Hamilton, Ontario, CANADA
FDA Status Not Applicable
Summary
This systematic review found that a high rate of children and adolescents return to sport at any level and at the competitive level after surgical management of osteochondritis dissecans of the elbow, with an overall return to any level of sport of 97.6% and a return to competitive sport of 86.9% with additional improvement in all postoperative functional outcome scores.
Abstract
Purpose
The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow.
Methods
The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score.
Results
Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a mean age of 14.1 (range 10-18.5) and a mean follow-up of 42.5 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic – assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI, 94.8%-99.5%, I2=32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI, 70%-87.1%, I2=78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI = 77.3%-94.5% I2=64.3%), and the return to sport for overhead athletes was 89.4% (95% CI, 82.5%-95.1%, I2=59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI = 91.3% - 99.6%, I2=1%) and for an open procedure was 97.8% (95% CI 93.7%-99.9% I2=46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients).
Conclusion
Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures.