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Sasaki K, Fujita D, Takatsuji K, Kotoura Y, Minami M, Kobayashi Y, Sukenari T, Kida Y, Takahashi K, Kobashi S. Deep learning-based osteochondritis dissecans detection in ultrasound images with humeral capitellum localization. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-023-03040-8. [PMID: 38233599 DOI: 10.1007/s11548-023-03040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/15/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE Osteochondritis dissecans (OCD) of the humeral capitellum is a common cause of elbow disorders, particularly among young throwing athletes. Conservative treatment is the preferred treatment for managing OCD, and early intervention significantly influences the possibility of complete disease resolution. The purpose of this study is to develop a deep learning-based classification model in ultrasound images for computer-aided diagnosis. METHODS This paper proposes a deep learning-based OCD classification method in ultrasound images. The proposed method first detects the humeral capitellum detection using YOLO and then estimates the OCD probability of the detected region probability using VGG16. We hypothesis that the performance will be improved by eliminating unnecessary regions. To validate the performance of the proposed method, it was applied to 158 subjects (OCD: 67, Normal: 91) using five-fold-cross-validation. RESULTS The study demonstrated that the humeral capitellum detection achieved a mean average precision (mAP) of over 0.95, while OCD probability estimation achieved an average accuracy of 0.890, precision of 0.888, recall of 0.927, F1 score of 0.894, and an area under the curve (AUC) of 0.962. On the other hand, when the classification model was constructed for the entire image, accuracy, precision, recall, F1 score, and AUC were 0.806, 0.806, 0.932, 0.843, and 0.928, respectively. The findings suggest the high-performance potential of the proposed model for OCD classification in ultrasonic images. CONCLUSION This paper introduces a deep learning-based OCD classification method. The experimental results emphasize the effectiveness of focusing on the humeral capitellum for OCD classification in ultrasound images. Future work should involve evaluating the effectiveness of employing the proposed method by physicians during medical check-ups for OCD.
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Affiliation(s)
- Kenta Sasaki
- Graduate School of Engineering, University of Hyogo, Himeji, Hyogo, Japan
| | - Daisuke Fujita
- Graduate School of Engineering, University of Hyogo, Himeji, Hyogo, Japan
| | - Kenta Takatsuji
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiro Kotoura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Minami
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Kobayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuyoshi Sukenari
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshikazu Kida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Syoji Kobashi
- Graduate School of Engineering, University of Hyogo, Himeji, Hyogo, Japan.
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Nissen C, Bohn DC, Crepeau A, Edmonds E, Ganley T, Kostyun R, Lawrence JTR, Pace JL, Saluan P, Uquillas C, Wall E, Wilson PL, Bae DS. Reliability of Radiographic Imaging Characteristics for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2022; 50:3948-3955. [PMID: 36326355 DOI: 10.1177/03635465221130452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking. PURPOSE To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Anteroposterior, lateral, and oblique radiographs for 29 cases were reviewed by 7 orthopaedic surgeons. Images were assessed for elbow anthropometry and morphology, OCD presence, lesion characteristics, the presence of progeny bone and progeny features, and radial head abnormalities. Intra- and interrater reliability was assessed using Fleiss and Cohen kappa for nominal variables and intraclass correlation coefficients (ICCs) for continuous variables. RESULTS Surgeons demonstrated substantial to excellent inter- and intrarater reliability when assessing elbow characteristics: anthropometric (interrater ICC, 0.94-0.99; intrarater ICC, 0.82-0.96) and morphologic (Fleiss, 0.61-0.76; Cohen, 0.68). When the OCD lesion was assessed, fair to moderate interrater agreement was found for classifying the absence or presence of a lesion (Fleiss, 0.28-0.46) and the location of the OCD (Fleiss, 0.24-0.52), poor agreement for assessing the contour of the lesion (Fleiss, 0.00-0.09), and excellent agreement for measuring the size of the lesion (ICC, 0.82-0.94). Poor to fair interrater agreement was found for radial head abnormalities (Fleiss, 0.00-0.27). Progeny bone visualization and fragmentation demonstrated moderate interrater agreement (Fleiss, 0.43-0.47) where displacement of the bone demonstrated poor interrater agreement (Fleiss, 0.11-0.16). Intrarater agreement for OCD lesion characteristics, progeny bone visualization, and progeny bone features was moderate to excellent. CONCLUSION Given only the fair to moderate agreement among raters for identifying OCD on radiographs, this imaging modality may not serve as a dependable screening tool in isolation. Additional imaging should be obtained if the clinical presentation suggests capitellar OCD and a definitive diagnosis is not possible with radiographs. However, clinicians can reliability measure the size of radiographically apparent OCD, suggesting that radiographs may serve as an appropriate imaging modality for follow-up care.
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Affiliation(s)
| | - Carl Nissen
- PRiSM Sports Medicine, Hartford, Connecticut, USA; Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | - Allison Crepeau
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Eric Edmonds
- Rady Children's Hospital, San Diego, California, USA; University of California San Diego, San Diego, California, USA
| | - Theodore Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Regina Kostyun
- Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | - J Todd R Lawrence
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | | | - Carlos Uquillas
- Cedars Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Eric Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald S Bae
- Boston Children's Hospital, Boston, Massachusetts, USA.,Investigation performed at the Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
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Common Upper Extremity Injuries in Pediatric Athletes. Curr Rev Musculoskelet Med 2022; 15:465-473. [PMID: 35913666 PMCID: PMC9789231 DOI: 10.1007/s12178-022-09784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation. RECENT FINDINGS Shoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes. There is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.
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Effect of introducing ultrasonography in medical examinations for elbow injuries among young baseball players. J Med Ultrason (2001) 2022; 49:463-469. [PMID: 35633406 DOI: 10.1007/s10396-022-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study investigated the usefulness of ultrasonography in medical examinations for detecting elbow injuries, especially capitellar osteochondritis dissecans, among young baseball players. METHODS Players with current or previous elbow joint pain were enrolled. Medical examinations (range of motion, tenderness, and stress tests) were performed with (2012-2016) or without (2007-2011) ultrasonography. Players with abnormal examination results were advised to undergo additional examinations at a local orthopedic clinic. Differences in the rates of capitellar osteochondritis dissecans detection, secondary examination, and elbow injury prevalence were compared between players who did and did not undergo ultrasonography. RESULTS We identified 1045 baseball players, aged 9-12 years, who required medical examinations for elbow injuries. Medical examinations without ultrasonography were performed in 346 players (group A), and examinations with ultrasonography were performed in 556 players (group B). Capitellar osteochondritis dissecans was present in 0.3% (1/346) of group A players and 3.0% (17/556) of group B players (p = 0.003). The secondary examination consultation rates were 51.2% (62/121) and 66.0% (270/409) in groups A and B, respectively (p = 0.004). CONCLUSION Ultrasonography performed as a part of a medical examination can help detect elbow injuries, especially capitellar osteochondritis dissecans, in baseball players. Using ultrasonography in conjunction with medical examinations may contribute to a better understanding of elbow injuries in baseball players and improve consultation rates. Thus, ultrasonography is essential for the evaluation of elbow injuries in young baseball players.
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Pu A, Jauregui JJ, Salmons HI, Weir TB, Abzug JM, Gilotra MN. Radiographic evaluation of osteochondritis dissecans of the humeral capitellum: A systematic review. J Orthop 2021; 27:114-121. [PMID: 34594097 DOI: 10.1016/j.jor.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/12/2021] [Indexed: 02/01/2023] Open
Abstract
Background The purpose of this study was to evaluate radiographic-based classification systems for osteochondritis dissecans (OCD) of the capitellum and determine their agreement with intraoperative findings. Methods Using PRISMA guidelines, we analyzed 44 studies utilizing a total of 19 classification systems. Results Magnetic resonance imaging (MRI)-based systems showed better predictive value of intraoperative staging, and the Itsubo and Kohyama classifications showed best predictive value for lesion stability. Conclusions No classification system effectively correlated with intraoperative findings. A combination of radiograph, MRI, and computed tomography will most accurately determine OCD lesion stability. Level of evidence IV, Systematic Review.
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Affiliation(s)
- Alex Pu
- Department of Orthopedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300. Baltimore, MD, 21201, USA
| | - Julio J Jauregui
- Department of Orthopedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300. Baltimore, MD, 21201, USA
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tristan B Weir
- Department of Orthopedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300. Baltimore, MD, 21201, USA
| | - Joshua M Abzug
- Department of Orthopedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300. Baltimore, MD, 21201, USA
| | - Mohit N Gilotra
- Department of Orthopedics, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor Suite 300. Baltimore, MD, 21201, USA
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Uno T, Takahara M, Maruyama M, Harada M, Satake H, Takagi M. Qualitative and quantitative assessments of radiographic healing of osteochondritis dissecans of the humeral capitellum. JSES Int 2021; 5:554-560. [PMID: 34136870 PMCID: PMC8178641 DOI: 10.1016/j.jseint.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about the optimal timing of early return to sports after which the osteochondritis dissecans (OCD) lesion can completely heal. The aims of this study were to investigate the clinical outcomes of nonoperative treatment and elucidate the relationship between the radiographic findings and the timing for the return to sports. Methods We performed a retrospective review of 32 patients who presented with stable OCD of the capitellum and were treated nonoperatively for a minimum of 3 months. The mean follow-up period was 22.1 months. OCD lesions were assessed qualitatively and quantitatively on anteroposterior radiographs of the elbow at 45° of flexion every 3 months. The width of the OCD lesion (OCDw) and lateral width of the normal capitellum were measured and were associated with return to sports activities. Results In 21 patients (66%), the progression of ossification was seen at a mean period of 4.1 months. Eighteen (56%) had partial union at a mean period of 4.3 months. Twenty-nine cases (91%) returned to sports activities after a mean of 4.6 months. Nine cases (28%) achieved complete union after a mean period of 15.0 months. Fifteen (47%) required surgery after a mean period of 11.8 months. The mean OCDw (%) was 10.2 ± 3.9 mm (56%) at the initial presentation and 8.0 ± 6.0 mm (41%) at the final follow-up examination, and the decrease in OCDw was 2.2 ± 3.1 mm (15%). The mean decrease in OCDw in patients with progression of ossification during the first 3 months was significantly larger than in patients without progression of ossification (4.9 ± 4.7 mm and -0.7 ± 4.5 mm, respectively; P = .002). In patients who had both an OCDw value of <8.0 mm and a lateral width value of >2.0 mm at the time of the return to sports, the rate of successful nonoperative treatment (86%) and complete union (71%) was significantly higher in comparison with other patients (P = .03 and P = .02). Conclusions OCD lesions showed difficult healing in the middle one-third of the capitellum. The progression of ossification during the first 3 months was a significant predictor of successful nonoperative treatment and complete union. Surgery should be considered for lesions without the progression of ossification during the first 3 months. We propose both an OCD lesion width of <8.0 mm and a lateral normal width of >2.0 mm as radiographic landmarks of the timing of the return to sports.
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Affiliation(s)
- Tomohiro Uno
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan.,Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masatoshi Takahara
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mikio Harada
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Allahabadi S, Bryant JK, Mittal A, Pandya NK. Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes. Orthop J Sports Med 2020; 8:2325967120963054. [PMID: 33225011 PMCID: PMC7658530 DOI: 10.1177/2325967120963054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Osteochondral injuries of the elbow are limiting and affect the ability of pediatric and adolescent athletes to participate in sports. Purpose: To report short- and midterm outcomes on athletes undergoing microfracture or fragment fixation of osteochondral elbow lesions and evaluate the effects thereof on sporting activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study analyzing patients who underwent surgical treatment via microfracture or fragment fixation for osteochondral elbow lesions. Patients were treated at a single institution by a single surgeon between 2012 and 2019. Diagnosis was confirmed with magnetic resonance imaging, and patients were indicated for surgery after having persistent symptoms despite trialing rest, immobilization, and/or activity restriction for at least 3 months. Demographic data including sports of choice were collected preoperatively. Imaging and intraoperative findings were documented, and any complications were noted. Range of motion (ROM) was compared pre- to postoperatively. Return-to-sport evaluation included the ability to play the preoperative sport of choice. Results: In total, 23 patients (25 elbows) were included with a mean follow-up of 23.5 months (range, 6-60.3 months) and a mean age of 13.8 years. Of 25 lesions, 20 (80%) were on the athlete’s dominant side. There was significant improvement from pre- to postoperative ROM, including extension (mean ± SD, 6.4° ± 5.3° to 0.04° ± 0.2°; P < .00001), flexion (129.2° ± 10.6° to 138.6° ± 4.4°; P = .00013), and arc of ROM (122.6° ± 13.2° to 138.6° ± 4.4°; P < .00001). Mean lesion size was 81.9 ± 59.3 mm2 (range, 15-225 mm2). All elbows demonstrated radiographic healing postoperatively. Mean time to release to sport was 4.48 ± 1.38 months (range, 2.5-8 months). Six (26.1%) patients changed or stopped their preoperative sporting activity, including 2 of 4 gymnasts and 4 of 11 baseball players. Conclusion: Arthroscopic technique with lesion debridement and microfracture or fixation appears safe and results in radiographic healing; however, with these techniques, there remains a high rate of inability to return to sport in patients involved in higher-demand upper extremity activity, such as baseball and gymnastics. Further treatment strategies, including cartilage restoration procedures, may be warranted in this population.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jessica K Bryant
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ashish Mittal
- San Francisco Orthopedic Residency Program, St Mary's Medical Center, San Francisco, California, USA
| | - Nirav K Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Zaremski JL, Zeppieri G, Tripp BL. Injury Prevention Considerations in Adolescent Overhead-Throwing Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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