Osteophytes in the dorsal aspect of the capitellum were significantly associated with lower range of motion and Mayo Elbow Performance Score in patients with elbow osteoarthritis, based on a 3D CT analysis of 97 surgical cases.
Researchers used a novel bony landmark–based classification system to map osteophyte locations and identify correlations with clinical impairment.
The retrospective study analyzed 97 patients (80 males, 17 females) with elbow osteoarthritis (OA), who underwent arthroscopic surgery between May 2013 and April 2024. The mean patient age was 46.8 years (SD, 11.4). A total of 69 patients (71.1%) had surgery on the right arm, and 70 patients (72.2%) had surgery on their dominant side.
Preoperative CT scans were constructed into 3D elbow models and divided into 11 anatomical regions using defined bony landmarks. Osteophytes were identified and recorded in each region. Patients were grouped using Qian’s range of motion (ROM) classification (Group A: ≥100°, Group B: 50–99°, Group C: <50°) and MEPS categories (Group I: ≥75, Group II: 60–74, Group III: <60).
Range of motion was measured manually, and Mayo Elbow Performance Score (MEPS) scored from 5 to 100. Two fellowship-trained elbow surgeons performed blinded assessments of the imaging data. Interobserver and intraobserver reliability were calculated using Cohen’s κ statistic.
All patients had osteophytes in at least one region. The most common sites were the olecranon (region 9, 92.8%), coronoid process (region 10, 88.7%), and olecranon fossa (region 6, 73.2%). However, only region 7 (dorsal capitellum) showed statistically significant associations with impaired ROM and MEPS.
Among patients with region 7 osteophytes (n = 51), mean ROM was 65° (SD, 28°) and MEPS was 69.5 (SD, 18.5), compared to 81° (SD, 31°) and 79.0 (SD, 15.8) in those without osteophytes (n = 46; P = .009 and P = .007, respectively). Region 7 osteophyte incidence increased across declining ROM groups: 20.0% in Group A, 55.2% in Group B, and 78.9% in Group C (P = .001). Similarly, prevalence rose with worsening MEPS: 40.7% in Group I, 52.6% in Group II, and 89.5% in Group III (P = .001).
“The presence of osteophytes in region 7 may serve as a imaging indicator of elbow OA patients with more severe symptoms,” said Renjie Chen, MD, of the Sports Medicine Department at Beijing Jishuitan Hospital, Capital Medical University, China, and colleagues.
“Osteophytes at the dorsal aspect of the capitellum significantly affected both elbow ROM and MEPS.”
The classification system showed strong interobserver (κ = 0.894) and intraobserver (κ = 0.908) agreement (both P < .001).
However, the study excluded patients over 65 years and those with forearm rotational limitations, which may reduce generalizability. The male-to-female ratio was disproportionate, and subgroup sizes limited some comparative analyses. No postoperative outcomes were reported, and a control group was not included.
Osteophytes in the dorsal capitellum were linked to reduced ROM and MEPS in elbow OA patients. Preoperative identification of region 7 osteophytes may help guide surgical decision-making.
Future studies should assess postoperative changes and include broader, more balanced cohorts.
The authors reported no conflicts of interest.
