O3233: Are Elbow Ocds Different for Weightbearing and Throwing Athletes?

Background: Though relatively uncommon in the non-athletic population, osteochondritis dissecans (OCD) lesions of the elbow are one of the most common types among athletes who perform repetitive overhead activities. OCD lesions can develop in weightbearing athletes, such as gymnasts, and throwing athletes, such as baseball players. These athletes have different mechanisms of loading on their elbows, and there is little data comparing OCD lesions between these two sports. The purpose of this study is to compare the clinical and imaging characteristics of elbow OCD lesions between weightbearing and throwing athletes.

Methods: This was a retrospective review using an OCD lesion database at the home institution. Patients who presented to orthopaedic surgery or sports medicine clinics between January 1, 2015, and January 1, 2022, were included. Athletes who had an elbow OCD lesion and an MRI of their lesion were included. Primary outcomes of interest included location of elbow OCD lesion on the capitellum, stability of lesion, lesion size, and the presence of a radial head deformity.

Results: 34 total patients (65% male) were included in the study. 22 of these (65%) were baseball players and 12 (35%) were gymnasts. Average age was 12.82 ± 1.48 years. There was no difference in age (p=0.66), race (p=0.32) or skeletal maturity (p=0.82) between groups. 97% (33/34) of athletes had a capitellar lesion. 76% of athletes had a radial head deformity present on elbow radiographs and there was no difference in the occurrence of this between weightbearing (17/22 [77%]) and throwing (9/12 [75%]) athletes (p=0.61). There was no difference in frequency of lesion instability between groups (p=0.56). Baseball players had a higher frequency of lesions located anteriorly on the capitellum compared to gymnasts (28% vs 0%, p=0.02) and gymnasts had a higher frequency of lesions located centrally (24% vs. 58%, p=0.02). Gymnasts also had a significantly higher frequency of pain as their chief complaint whereas baseball more frequently experienced pain in addition to swelling and/or mechanical symptoms (p < 0.001).

Conclusion: There do not appear to be significant differences in the size, stability, or location of OCD lesions in weightbearing and throwing athletes. The presence of an associated radial head deformity was seen on most radiographs without any difference between type of sport. An athlete’s symptoms at presentation were found to be significantly different between baseball players and gymnasts. Though previous studies have investigated elbow OCD lesion location between weightbearing and throwing athletes, this is among the first to investigate stability, radial head deformity, patient symptoms, and range of motion. However, future studies with more power are needed to better delineate any significant differences in elbow OCD lesions between weightbearing and throwing athletes. This will help physicians understand this population more clearly and tailor treatment appropriately.