Osteochondral lesions of the humeral trochlea in the young athlete.

Publication/Presentation Date

5-1-2009

Abstract

OBJECTIVE: The purpose of this study was to characterize the variety of osteochondral abnormalities of the humeral trochlea in the pediatric athlete.

MATERIALS AND METHODS: Patients with trochlear abnormalities were identified through keyword search of radiology dictations from 1999 to 2007. The patient's medical record, imaging studies, and surgical reports were reviewed. The osteochondral lesions were categorized based on the imaging appearance. Surgical results were reviewed in conjunction with the imaging findings.

RESULTS: Eighteen patients were identified. Trochlear lesions were stratified into two imaging groups: Osteochondral injury/osteochondritis dissecans (OCD) vs. avascular necrosis (AVN). The osteochondral injury group was stratified into medial and lateral trochlear abnormalities. The medial lesions (n = 3) were small (<6 >mm) and were located on the posterior articular surface of the medial trochlea. The lateral lesions (n = 10) were larger (10-14 mm), circumscribed, and were located on the posterior inferior aspect of the lateral trochlea. Trochlear AVN (n = 5) affected development of the lateral trochlea (type A) or both the medial and lateral aspects of the trochlea (type B). AVN occurred exclusively in athletes with history of remote distal humeral fracture. Seven of the 18 patients underwent elbow arthroscopy. Surgical findings and treatment regimens are summarized.

CONCLUSION: Trochlear lesions should be considered in throwing athletes presenting with medial elbow pain and flexion contracture/extension block. Medial trochlear osteochondral injuries may result from posteromedial olecranon abutment. Lateral OCD lesions occur in a characteristic vascular watershed zone resulting from the unique blood supply of the trochlea. Trochlear AVN may be unmasked years following treated distal humeral fracture when the athletic demands upon the adolescent elbow increase, revealing the altered growth and biomechanics.

Volume

38

Issue

5

First Page

479

Last Page

491

ISSN

0364-2348

Disciplines

Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology

PubMedID

19221737

Department(s)

Department of Radiology and Diagnostic Medical Imaging

Document Type

Article

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