Elbow arthroscopy for cartilage lesions _ Chondromatosis

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Elbow arthroscopy for cartilage
lesions_Chondromatosis OCD
P. CLAVERT, F. KELBERINE, and the SFA Shoulder
and Elbow ServiceUniversity Hospital - Strasbourg
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The French Experience
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Loose body - Epidemiology

• 61 cases of LB ? chondromatosis
• Mean FU 14 m
• 92 Men
• Mean age 37 y (13-65)
• 57 R - 62 dominant side
• Symptoms duration 22 m

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Pre-op Imaging studies

• Standard XRays 100 2 LB
• Arthro-CT 79 3 LB
• Arthro-MRI 5

more reliable
associated pathology
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Arthroscopy

• Mean LB found 2,83
• 8 cases more LB found than number at CT
• Associated procedures
• Synovial biopsy 10/61 cases
• Cartilage lesions debridement 25/61 cases
• 2 patients LB left

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Symptomatology

• Pre-op symptoms
• Blockage 61
• Cracking 84
• Swelling 51
• Pain 2/5
• Discomfort 3/5

• Post-op symptoms
• Blockage 3
• Cracking 13
• Swelling 8
• Pain 1/5
• Discomfort 1/5

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Arc of motion

• Pre-op ROM
• Flexion 122 90-140
• Extension -18 0- (-80)
• Pronation 86
• Supination 81

• Post-op ROM
• Flexion 132 100-140
• Extension -6 0- (-50)
• Pronation 86
• Supination 82

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Subjective results

• Subjective Results
• 4 17 pt
• 3 16 pt
• 2 17 pt
• 1 8 pt
• 0 2 pt
• Arthroscopy
• Good results function - pain - subjective results

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Chondromatosis

• Metaplasic synovium - loos body of cartilage
• Chondromas within the synovium
• Free loos bodies
• Normal synovium - volume increase of the LB

Rare Symptomatic Imaging studies are helpfull
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Chondromatosis

• Standard XRays
• Artho-CT
• MRI Arthro-MRI

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Surgical procedure

• Arthroscopy
• Removal of the loose bodies
• Synovectomy if needed

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Retrospective Study

• Epidemiology
• 10 patients (8M - 2W)
• 11 elbows (7R - 4L)
• 53 y (33 - 77)
• Symptoms durations 11 m
• 4 repetitive microtrauma

• Pre-op symptoms
• Blockage 61
• Cracking 84
• Swelling 51
• Pain 2/5
• Discomfort 3/5

Milgram JW JBJS Am 1977 Dorfmann Arthroscopy
1989 Milgram JW JBJS Am 1977
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Retrospective Study
FU 14 m (4 - 72)

• Mean nbr of LB 18 (Max 48)
• Synovectomy 9 cases
• PROM gain 30 Flex- Ext
• Patient Satisfaction 3 Excellent 7
  good 1 poor but arthrosis

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Chondromatosis LB

• Need of imaging studies with die
• Localization and LB numbering
• Status of the cartilage (prognosis)
• Treatment
• Removal of the LB
• /- synovectomy

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Osteochondritis Dissecans

• Definition - Franz Konig - 1889
• Focused avascular necrosis of the sub-condral
  bone - no more cartilage support
• Rare at the elbow
• Only 6 of the patients with an OCD
• Adolescent
• Fusion of the growth plate of the capitulum
• ? Osteochondrosis (Pannes deasis)

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Standard Xrays

• 4 stages
• Isolated osteolysis
• Condensation
• Attached free flap
• Loose body

Need of an Xray with the elbow flexed at 45
(Takahara - JBJS Am - 1998)
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MRI

• Early diagnosis - infraclinical
• Hyposignal in T1
• Normal signal in T2or hypersignal

Prognostic and therapeutic Value
Takahara - JBJS 1998
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Classification - indications
Baumgarten et al. AJSM 98
Petrie Bradley - 2003
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Retrospective study

• Demographic data
• 12 patients (13 elbows)
• 9 boys (1 bilat) / 3 girls
• Age 16 y (10-22)
• Dominant side 11/13 (85)
• Prior elbow trauma 15
• Repetitive microtrauma 85
• Sports tennis (7) gym (3) table tennis (1)

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Retrospective study

• Clinical presentation
• Blockages 10/13
• Cracking 13/13
• Swelling 12/13
• Pain at rest 13/13
• Discomfort 13/13
• Arc of motion
• F/E -21 / 123
• P/S 85 / 77

• Radiology
• LB (1 à 2) 9/13
• Osteophytes 2/13
• JS narrowing 5/13
• True OCD 12/13
• Arthro-CT 6/13
• MRI 5/13
• Synovitis 9/11

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Retrospective studyarthroscopic evaluation

• Cartilage
• Chondropathy 13/13
• Lateral condyle 13/13 (free flap)
• Radial Head 1/13 (miror lesion)
• Loose body
• Mean 1.7 (1 à 3)

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Retrospective studyProcedures

• LB removal 17
• Osteophytes resection 3
• Cartilage
• Shaving 13/13
• Debridement 8/13
• Free flap resection 13/13
• microfracture 3/13
• Synovectomy 6/13
• No complication

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Retrospective studyResults

• Blockage 0/13
• Cracking 3/13
• Swelling 0/13
• Pain slight 3
• Discomfort moderate 1
• PROM
• Extension-flexion -5 / 134
• Pronotion-supination 85 / 84

• Standard Xrays 13/13
• Arthro-CT 0/13
• MRI 5/13
• JS narrowing 6/13
• Ostéophytes 3/13
• Synovitis 2/5 IRM

Mean FU 38 months (2-129)
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Retrospective studySubjective results

• Patients satisfaction
• Excellent 8/13
• Very good 4/13
• good 1/13
• Sports activity
• 2 m (1 to 4 m)
• Same level 9/11
• 2 stopped their activities

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Discussion

• Arthroscopy
• Symptoms relief
• Not a treatment of the etiology
• Future
• Mosaic plasty
• Osteotomy
• Cartilage grafts

Kiyoshige AJSM 2000
Nakagawa AJSM 2001
Sato - JSES 2004
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Thank You