Daniel Quintero
Background: Osteochondritis dissecans (OCD) in the elbow commonly occurs in the pediatric population. However, trochlear OCD is rarely documented in the literature. Therefore, we conducted a literature search for all reported cases of trochlear OCD as well as presented two additional cases of trochlear OCD from our institution. Based on a combination of all cases, we describe a novel classification system for trochlear OCD. After presenting two novel cases of trochlear OCD, a review of literature for all known cases of OCD in the trochlea was conducted. Exclusion criteria included: nonrelated topics, location other than trochlea of the elbow, nonhuman subjects, and non-English language papers. We then classified lesions based on lesion to radial head ratio via review of elbow AP radiographs. We believe the larger the lesion to radial head ratio, the more likely the patient would undergo operative intervention for treatment. Our literature search yielded fortyone articles. After removing duplicates and excluded articles, nine manuscripts remained. Including our cases, this yielded twenty-four patients with twentyfive cases of OCD. Patients with a lesion to radial head ratio of greater than 0.45 underwent operative intervention with the exception of two cases.
Conclusion: Due to the rarity of trochlear OCD, there is no high-level evidence reported in the literature to guide diagnosis or treatment. Based on this review of literature, OCD of the trochlea of the elbow can be appropriately managed with thorough history taking, adequate characterization of lesion radiographically and treatment with operative or non-operative measures based on the severity of clinical symptoms and extent of lesion based on radiographic findings. We also hope that the proposed lesion to radial head ratio on the AP radiograph might be a valuable tool to characterize lesions in conjunction with the OCD grade of the lesion which is difficult to reliably perform with plain radiographs.
