Review Question - QID 219963

This 8-year-old boy has been experiencing right elbow pain, with radiographic findings suggesting Panner's disease of the capitellum. A full range of motion following the resolution of the condition is a reasonable expectation (Answer 4).

Osteochondrosis of the capitellum (OCC), otherwise known as Panner's Disease, is a rare condition encountered in clinical practice. While similar to osteochondritis dissecans (OCD), it is considered a separate entity. Following repetitive trauma involving valgus moments of the elbow, OCC results from ischemia within the epiphysis of the capitellum, which then undergoes a process similar to Legg-Calve-Perthes in the hip, where flattening and fragmentation of the entire capitellum initially results, which is then followed by reossification. This is in comparison to OCDs, where there is a focal osteochondral lesion secondary to repeated stress that occurs within the capitellum. The former process occurs in those between the ages 5 and 10, whereas the latter occurs in those after 10, where the capitellum exhibits more robust ossification, allowing osteochondral lesions to develop. With nonoperative treatment, full resolution of symptoms without limitations in motion can be expected, while radiographic changes are often permanent in the form of contour irregularity and subchondral sclerosis.

Claessen et al. performed a systematic review of 23 studies (n=30) examining the etiology, presentation, associated diagnostic imaging, and treatment of pediatric patients presenting with OCC. Most patients were male (90%) with a history of elbow contusion (43%). The most common symptoms were limitations in range of motion (86%), which were typically accompanied by pain (66%) and swelling (55%). Irregularity of the capitellum was commonly seen on plain films (43%), while fragmentation if not uncommonly encountered (27%). Of those reporting outcomes, most experience near-complete recovery (93%), with one reporting a permanent extension deficit. The authors conclude that non-operative treatment should be the mainstay for patients with OCC.

Eichman et al. provide a case report on a 14-year-old male with osteochondral lesions of the bilateral trochlea within the knee. After evaluation and diagnostic workup, the decision was made for the patient to undergo arthroscopic debridement with microfracture and application of dehydrated, micronized allogeneic cartilage. No complications occurred following the surgery, and the patient was able to return to sport/full activity.

Figures A and B represent orthogonal views of a skeletally immature individual's right elbow demonstrating irregularity of the capitellum with subchondral radiolucency, suggesting bony resorption.

Incorrect Answers:
Answer 1: patients most often present to the clinic with symptoms, namely limitations in range of motion, pain, and swelling
Answer 2: the condition is believed to stem from repeated stress, in the form of valgus maneuvers
Answer 3: nonoperative treatment is the mainstay treatment, with a high rate of success
Answer 5: cortical irregularity often persists into adulthood following Panner's disease