AJSM - 2026-08-06 - Journal Article
Preoperative Proximal Migration of the Radial Head as an Independent Predictor of Suboptimal Outcomes After Osteochondral Autograft Transplantation for Capitellar Osteochondritis Dissecans: A Retrospective Cohort Study.
Kamijo H, Takahashi N, Matsuki K, Ishii D, Akiyama T, Sugaya H, Kawashima I
Topics
Key Takeaway
Preoperative proximal radial head migration >2.2 mm independently predicts suboptimal outcomes after OAT for capitellar OCD (adjusted OR 1.47 per 1-mm increase; AUC 0.72), with 28% of adolescent athletes failing to achieve a Timmerman-Andrews score ≥160.
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Summary
This study evaluated preoperative radiographic predictors of suboptimal outcomes (T-A score <160) in adolescent athletes undergoing OAT for capitellar OCD. On multivariate logistic regression, proximal radial head migration was the sole independent predictor (adjusted OR 1.47/mm; 95% CI 1.03–2.09), with an ROC-derived cutoff of 2.2 mm (sensitivity 56%, specificity 84%). ROM and T-A scores improved significantly in all patients, and 100% returned to sport, but 19 of 69 elbows (28%) had suboptimal outcomes.
Key Limitation
Retrospective single-center design with only 69 elbows limits generalizability and statistical power to detect additional independent predictors, particularly for the low-sensitivity cutoff (56%) identified on ROC analysis.
Original Abstract
BACKGROUND
Osteochondral autograft transplantation (OAT) is widely performed for capitellar osteochondritis dissecans (OCD). However, preoperative predictors of suboptimal postoperative outcomes remain unclear.
PURPOSE/HYPOTHESIS
The authors aimed to evaluate clinical outcomes after OAT for capitellar OCD and identify preoperative risk factors associated with suboptimal outcomes. They hypothesized that radiographic indicators of disease severity, including preoperative proximal migration of the radial head, lesion size, and lateral wall disruption, would be associated with suboptimal postoperative clinical outcomes.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
The records of adolescent athletes who underwent OAT for capitellar OCD with a minimum 2-year follow-up were retrospectively reviewed. Clinical outcomes included elbow range of motion (ROM) and Timmerman-Andrews (T-A) score. A suboptimal outcome was defined as a postoperative T-A score <160. Preoperative radiographs were used to measure proximal migration of the radial head relative to the coronoid process, hypertrophy of the radial head, OCD lesion area, and a 5-grade lateral wall disruption classification; measurement reliability was assessed. Multivariate logistic regression analysis was performed to identify independent predictors of a suboptimal outcome, and receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value for proximal migration.
RESULTS
A total of 69 elbows (mean age, 13.6 years; mean follow-up, 48 months) were included. ROM and T-A scores improved significantly after OAT, and all athletes returned to any sports. Of these, 50 elbows (72%) achieved good outcomes, whereas 19 (28%) had suboptimal outcomes. Preoperative proximal migration was significantly greater in the suboptimal outcome group compared with the good outcome group (mean, 2.1 ± 2.3 vs 0.5 ± 1.7 mm; P = .002), as were lesion area (mean, 70 ± 16 vs 58 ± 20 mm 2 ; P = .02) and lateral wall disruption grade (median, 5 vs 3; P = .01). On multivariate analysis, proximal migration of the radial head was the only independent predictor of a suboptimal outcome (adjusted OR, 1.47 per 1-mm increase; 95% CI, 1.03-2.09; P = .033). ROC analysis showed an area under the curve of 0.72 with an optimal cutoff of 2.2 mm (sensitivity, 56%; specificity, 84%).
CONCLUSION
OAT resulted in significant clinical improvement in adolescents with capitellar OCD; however, 28% of patients were classified as having suboptimal outcomes. Preoperative proximal migration of the radial head is an independent predictor of a suboptimal postoperative outcome. A value >2.2 mm may indicate advanced radiocapitellar incongruity, a condition in which OAT may be less effective.