JBJS Case Connections—Osteochondritis Dissecans: Baseball and Genetics

The exact mechanism by which osteochondritis dissecans (OCD) lesions develop is poorly understood. This month’s “Case Connections” spotlights 3 case reports of OCD in young baseball players, 2 of whom developed the condition in the shoulder. A fourth case report details 3 presentations of bilateral OCD of the femoral head that occurred in the same family over 3 generations.

The springboard case report, from the December 28, 2016, edition of JBJS Case Connector, describes a 16-year-old Major League Baseball (MLB) pitching prospect in whom an OCD lesion of the shoulder healed radiographically and clinically after 8 months of non-throwing and physical therapy focused on improving range of motion and throwing mechanics. Three additional JBJS Case Connector case reports summarized in the article focus on:

• Shoulder OCD in a teenage baseball player that was treated arthroscopically
• Early elbow OCD in young throwers
• Three cases of bilateral femoral head OCD that occurred in multiple members of the same family

Among the take-home points emphasized in this Case Connections article:

• MRI arthrograms are the best imaging modality to determine the stability of most OCD lesions. Radiographs in such cases often appear normal.
• Early-stage OCD has the potential to heal spontaneously. Activity modification and physical therapy are effective treatments.
• There is not a “gold-standard” surgical intervention for treating unstable/late-stage OCD. Surgery frequently provides clinical benefits but often does not result in radiographic improvement.