Treatment of Pediatric Osteochondral Defects of the Elbow

Initial Management

Skeletally immature patients with stable lesions should receive activity restriction and immobilization as initial treatment, according to the American Academy of Orthopaedic Surgeons 1
Skeletally immature patients with symptomatic stable lesions failing ≥3 months of conservative treatment may be candidates for arthroscopic drilling, though evidence is inconclusive, as stated by the American Academy of Orthopaedic Surgeons 1

Osteochondral autograft transplantation (mosaicplasty) provides favorable outcomes with return to sports within 6 months for centralized or lateral localized lesions (<3 cm²), as reported by the American Academy of Orthopaedic Surgeons 2, 3
Osteochondral allograft transplantation (OAT) is appropriate for larger lesions (>2.5 cm²) or substantial subchondral bone loss, eliminating donor site morbidity while providing mechanically functioning hyaline cartilage, according to the American Academy of Orthopaedic Surgeons 2, 3

Patients receiving surgical treatment should be offered postoperative physical therapy, as recommended by the American Academy of Orthopaedic Surgeons 1
Patients remaining symptomatic after treatment require repeat history, physical examination, radiographs, and/or MRI to assess healing, according to the American Academy of Orthopaedic Surgeons 1

Surgery is indicated for osteochondral abnormalities causing mechanical symptoms or refractory pain, with the specific surgical approach determined by lesion location, stability, and skeletal maturity, as recommended by the American College of Radiology 4

Surgery is recommended for unstable or displaced osteochondral fragments, loose intra-articular bodies causing mechanical symptoms, and stable lesions that fail conservative management after appropriate immobilization, according to the American College of Radiology 4
Loose intra-articular bodies causing mechanical symptoms, such as locking or catching, require surgical intervention, as suggested by the American College of Radiology 4, 5

Plain radiographs are the mandatory first step to identify loose bodies, heterotopic ossification, and osteochondral lesions, as stated by the American College of Radiology 4, 5, 6
MRI or MR arthrography determines lesion stability and surgical planning, with MR arthrography having 100% sensitivity for detecting intra-articular bodies, according to the American College of Radiology 5, 7
CT arthrography evaluates osteochondral lesion stability with 93% sensitivity for loose bodies, as reported by the American College of Radiology 5, 7