Summary

The purpose of this systematic review was to determine the impact of patient sex on the outcomes following surgical treatment of OCD lesions of the elbow, but due to limited data provided in the literature regarding differences of OCD surgical treatment combined with the heterogeneity of data-points it was not possible to obtain conclusive information on this topic.

Abstract

Introduction

Osteochondritis dissecans (OCD) is a relatively rare condition that most commonly affects young athletes. Many studies have evaluated the outcomes of surgical treatment of OCD lesions; however, none have investigated the influence of patient sex on post-operative outcomes. The purpose of this systematic review was to determine the impact of patient sex on the outcomes following surgical treatment of OCD lesions of the elbow.

Methods

A systematic review was performed using PubMed, PubMed Central, Embase, OVID, and Cochrane Library databases per PRISMA guidelines. The search terms included “osteochondritis dissecans” AND “elbow” AND “male” OR “female” OR “sex” OR “gender” to gather all relevant articles. Data was collected on all studies that fit our inclusion criteria.

Results

977 studies were identified through the initial database searches. After omitting duplicates, 426 studies remained. Titles and abstracts were screened for relevance and 345 additional studies were then removed based on inclusion and exclusion criteria, leaving 81 studies for review. The full text for all 81 articles was reviewed, seven of which met all inclusion criteria and were included in the systematic review. A meta-analysis could not be performed given the heterogeneity within the dataset. Most studies included only looked at one outcome within their study and there was little to no overlap of outcomes examined between studies. Outcomes including VAS scores, range of motion, MAYO Elbow Performance score (MEPS) score, and more were studied, but because so many different outcome measurements were used and there was little homogeneity between studies and no concrete conclusions could be drawn. In one study, males appeared to have better improvement of VAS scores following OCD surgical treatment (difference of 3.3 points and 5.7 points at rest and during motion, respectively, for males and difference of 2.3 and 4.3 points for females, respectively.). In another, males experienced a greater improvement in elbow flexion (+1.6 degrees for males, -7.8 degrees for females) than females. Other data points examined were performance scores, histological findings, return to sport, and post-operative outcomes. The data from these data points were either not significantly different or did not include enough females in their population to determine if a difference between sexes existed.

Conclusion

The limited data provided in the literature regarding differences of OCD surgical treatment combined with the heterogeneity of data-points studied makes it impossible to draw any concrete conclusions of differences based on sex. While included studies demonstrated improved VAS scores and greater improvement of elbow flexion post-operatively in males, this data was not corroborated by other studies included in this review. As a result, greater conclusions cannot be drawn by taking the included studies together in the form of a review. Future studies should include patient sex as a variable when evaluating outcomes following surgical management of elbow OCD lesions and continue to explore previously reported differences between male and female patient in post-operative outcome measures to better understand the influence of patient sex on postoperative outcomes.