Japanese version of the Patient-rated elbow evaluation score correlates with physician-rated Japanese orthopaedic association-Japan elbow society elbow function score

Comprehensive Elbow Joint Morphology Changes in Surgically Treated Osteochondritis Dissecans of the Capitellum: Clinical Implications

Background

Capitellar osteochondritis dissecans (OCD) frequently results in radial head enlargement. However, due to the elbow joint's complex anatomy, deformities likely extend beyond just the radial head.

Hypothesis/Purpose

It was hypothesized that in patients with OCD treated with surgery, imbalances in bone morphology during growth would affect the entire joint, leading to postoperative clinical symptoms. The purpose of this study was to test this hypothesis through a 3-dimensional evaluation of morphological changes.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

After retrospective identification, this study enrolled 47 patients who had undergone surgery, with a mean postoperative follow-up of 6.8 years. After in-person evaluation and bilateral computed tomography scanning, 3-dimensional bone models of the affected and contralateral elbows were created. The bone morphology of the radial head, the distal humerus, and the proximal ulna at the anatomic points were evaluated and compared between affected and contralateral sides. These measurements were correlated with clinical symptoms, and risk factors for these changes were identified.

Results

The mean age at examination was 20.6 ± 3.3 years and at surgery was 13.9 ± 1.3 years, with a mean follow-up of 6.8 ± 3.2 years. In the radial head, morphological enlargement was observed for radioulnar diameter (26.3 ± 1.9 vs 22.9 ± 1.5 mm; P < .001) and dorsovolar diameter (26.5 ± 1.9 vs 24.2 ± 1.5 mm; P < .001). In the humeral trochlea, enlargement was noted at the lateral trochlea (28.2 ± 1.7 vs 25.0 ± 1.3 mm; P < .001), trochlear groove (20.4 ± 1.7 vs 17.9 ± 1.6 mm; P < .001), and medial trochlea (30.5 ± 2.1 vs 25.5 ± 1.6 mm; P < .001) as well as the ulnar trochlear notch (28.2 ± 1.7 vs 25.0 ± 1.3 mm; P < .001). Restricted elbow flexion was associated with radial head enlargement in radioulnar and dorsovolar diameters (R = 0.60, P < .001; R = 0.44, P = .002). Lesion size was identified as a risk factor for these changes (odds ratio [OR], 1.36; P = .019), as was development of OCD during skeletal growth (OR, 0.82; P = .006).

Conclusion

Over mid- to long-term follow-up, the entire elbow joint underwent cylindrical-like morphological changes, leading to restricted motion. Enlargement typically developed during skeletal growth, with larger lesions resulting in more severe enlargement. Awareness of these natural postoperative changes is crucial, and it is clinically important to provide appropriate treatment during skeletal growth when treating OCD.

Valgus instability and related factors beyond 2 years following unlinked total elbow arthroplasty

HYPOTHESIS AND BACKGROUND

Total elbow arthroplasty (TEA), categorized into linked and unlinked types, is a commonly reported treatment for rheumatoid arthritis of the elbow. Although unlinked TEA preserves bone, it may result in instability. This study aimed to assess the outcomes of unlinked TEA in rheumatoid arthritis of the elbow beyond 2 years and to identify factors correlating with postoperative valgus instability of unlinked TEA.

METHODS

This study included patients who underwent TEA for rheumatoid arthritis of the elbow at our department between August 2009 and January 2017, with a follow-up period exceeding 2 years. Elbow joint range of motion (ROM) and clinical scores were evaluated preoperatively and at the final follow-up. Factors contributing to valgus instability, such as the Larsen grade, sex, age, side, preoperative ROM, postoperative ROM, implant placement, preoperative carrying angle, and the use of biological disease-modifying antirheumatic drugs (bDMARDs), were also assessed.

RESULTS

This study encompassed 26 elbows from 23 patients, with a mean patient age at surgery of 64.8 years and a mean follow-up duration of 92.4 months. Significant improvements were observed in the ROM (extension: from -31° preoperatively to -21° postoperatively [P = .02], flexion: from 116° to137° [P < .001]), Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score (from 45.9 to 86.3 points [P < .001]), and Mayo Elbow Performance Score (from 43.6 to 91.7 points [P < .001]). At the last follow-up, 2 elbows exhibited radiolucent lines around the humeral stem, whereas 7 had valgus instability. Factors correlated with valgus instability included total arc at the final follow-up, preoperative carrying angle, and the use of bDMARDs.

DISCUSSION AND CONCLUSION

Unlinked TEA demonstrated favorable midterm outcomes for rheumatoid arthritis of the elbow, albeit with occasional valgus instability. Surgeons should consider preoperative carrying angle and bDMARD use, and exercise caution regarding intraoperative extensions.