Elbow Osteochondritis Dissecans - Arthroscopy and Microfracture

You/your child have just undergone surgical treatment for elbow osteochondritis dissecans (OCD) with Kemble.

This means he has looked into you/your child's elbow with a telescope, removed any loose pieces, smoothed out the OCD area, and performed microfracture - drilling of the OCD bed to promote healing. Additional healing "Gel" may have been injected over the top of the OCD lesion. 

This is usually done through an arthroscopic (key-hole) approach but may occasionally require a slightly bigger open incision. If the elbow was stiff due to the OCD, simultaneous contracture release may have been performed. 

The following is an example of such an OCD as viewed at arthroscopy

Post operative recovery

General expectations and post-operative management

  • Most of the time, a plaster is not required. Some pain is to be expected. You will be given pain killers.

  • The elbow will be wrapped in a bulky bandage which will help protect the wound.

  • Your arm will be in a sling. This is for comfort only. You do not HAVE to use the sling and are in fact encouraged to come out of the sling frequently to move your elbow so it does not stiffen up. Try to do this at least 10 times a day.

  • Frequently move your fingers/thumb, even when you are in the sling 

  • Early numbness or tingling in the first couple of days following surgery is not uncommon. This may be due to the local anaesthesia Kemble placed into your wound to help with the pain, or due to the anaesthetic block the anaesthetist put in your shoulder area. 

  • Please do not lift anything heavier than a cup of tea at this time. 

  • Please keep your dressing/bandage dry at all times. You may use a plastic bag tied above the elbow to prevent the dressing/wound from getting wet during shower/bathing

  • The outer bandage can be removed at home after 3-4 days. There will be water resistant dressings underneathe which should remain intact until review with Kemble.

  • Between 10-16 days following surgery, you should have your wound checked. There may be sutures that need to be removed.

Movement

  • Starting immediately after surgery, It is important you come out of the sling to try to move your elbow. Bend and straighten your elbow all the way or as much as you can. Do 10 repetitions of this and do this 10 times a day (100 reps)

  • Early movement of the elbow is important so your elbow does not stiffen up, or so the pre-existing stiffness can go away as quickly as possible

  • Moving the elbow may be uncomfortable or a little painful, however, it is important you still try to move it.

  • You should wean out of the sling over the next few days and be out of the sling altogether by the end of the first week after surgery. 

The following is your therapy prescription 

  • Limit weight-bearing to "cup of tea" for first 2 weeks

  • Start all active and passive ROM immediately following surgery. 

  • Out of sling altogether by day 5

  • First 6 weeks - can push range until pain threshold but do not push past it. After 6 weeks, can push range until past pain threshold

  • Can start strengthening at 6 weeks. 

  • Once 80% of ROM is restored, or 6 weeks has elapsed since surgery (whichever is later), can return to gentle sports training but no competitive sports yet

  • Gymnasts: at 6 weeks may begin to return to "non-flight" gymnastics. This means activities where one part of the body is always touching either the ground or the equipment. If this is well tolerated and there is no pain or locking of the elbow, may return to full gymnastics at 3 months following surgery. 

  • For throwers, at 2 months may begin to return to throwing. 

  • For basketball/netballers, consider retraining of throwing technique to avoid excessive valgus strain on elbow during throwing motion

  • Return to all competitive sports at 3 months if near full ROM and no symptoms of clicking/locking.

  • Pain at end of range is ok and normal. Pain associated with clicking/locking - please inform Kemble preferably via email: kemble@kemblewang.com

What to look out for

  • Continued drainage from the wounds that does not stop after 1 week

  • Suddenly deterioration in pain when previously pain has been improving

  • Sudden locking of the elbow and inability to bend/straighten

  • If any of the above is noted, please contact Dr Kemble Wang's team. 

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for professional medical advice.