Early Results of Drilling and/or Microfracture for Grade IV XXXX .

@entity1 @entity4 @entity1843
BACKGROUND: Surgical treatment is recommended for @entity1 with unstable @entity1843 ( @entity1843 ) of the elbow. However, little information is available comparing the anticipated results from the host of techniques. In this investigation, clinical and radiographic resolution as well as return to sports rates were assessed in adolescent @entity1 following loose body (LB) removal and drilling/microfracture of grade IV lesions. METHODS: We reviewed 21 adolescents treated with LB removal and drilling/microfracture for grade IV elbow @entity1843 . @entity1 with additional elbow pathology, prior elbow surgery, or <1 year follow-up were excluded. Clinical resolution was defined as resolution of tenderness and radiographic resolution as resolution of @entity4 on magnetic resonance imaging (MRI). Return to sport rates and Timmerman scores were assessed. Mean clinical and MRI follow-up times were 2.2  1.19 and 2.4  1.54 years, respectively. Clinical and radiographic parameters associated with clinical and/or radiographic resolution or return to sports were determined using penalized likelihood logistic regression. Wilcoxon signed-rank tests were used to evaluate the change in range of motion and in Timmerman scores. RESULTS: Fifteen (71.4%) @entity1 had either clinical or radiographic resolution at most recent follow-up. Nine (50%) had complete resolution on MRI, whereas 13 (61.9%) were nontender at their follow-up. Four @entity1 with recurrent LBs underwent revision surgery. There were no complications in the 21 index procedures. Eighteen (85.7%) @entity1 returned to any sport, whereas 14 (66. 7%) returned to their primary sport. Elbow flexion and extension improved by medians of 12 and 21 degrees, respectively (P=0.002, 0.01). Timmerman scores improved by a median of 30 (P=0.001). Shorter duration of symptoms correlated with @entity1843 (P=0.03) and with improved clinical or radiographic resolution and return to sport rates. CONCLUSIONS: The majority of @entity1 with grade IV elbow @entity1843 achieves clinical and/or radiographic resolution and return to sports 2 years after LB removal and drilling/microfracture. Recurrence may be seen, however, and further investigation is needed to assess the efficacy of this technique compared with other treatment strategies. LEVEL OF EVIDENCE: Level IV.
