Autologous Minced Cartilage Implantation for Arthroscopic One-Stage Treatment of Osteochondritis Dissecans of the Elbow

Extra-articular core tunneling and local autogenous bone grafting for osteochondritis dissecans lesion of the capitellum with intact articular cartilage and subchondral bone deficiency

“…Treatment options for OCD lesions generally include débridement, microfracture or drilling, autologous matrix-induced chondrogenesis, autologous and allogenic osteochondral transfer, cartilage transplantation, and autologous chondrocyte implantation. 13 , 18 Nonoperative management is the preferred treatment for stable lesions, 13 but up to 54% of patients will not improve from nonoperative treatment. 22 , 5 Accordingly, Logli et al 12 recently proposed a treatment algorithm that included operative management for patients with stable lesions who have been symptomatic for more than 3-6 months.…”

“… 14 , 15 , 20 This procedure is associated with satisfactory to excellent outcomes for more extensive OCD lesions with instability. 1 , 18 A review by Matsuura et al 15 found that in patients with unstable OCD lesions treated with the OAT procedure, 81 of 86 patients returned to previous level of sport with a mean follow-up of 43 months. A systematic review by Westermann et al 23 comparing patient’s return to sport after operative management of capitellar OCD lesions found return to previous level of sport was highest with OAT procedures (94% at mean follow-up 35.0 months) compared with débridement and marrow stimulation procedures (71%) or OCD fixation surgeries (64%).…”

“…Despite the reported positive long-term outcomes, the OAT procedure has associated risks including donor site morbidity and incomplete restoration of joint congruity and tribology at the graft recipient site. 18 While large or unstable cartilage defects in OCD lesions can benefit from the OAT procedure, large OCD lesions with stable or salvageable articular cartilage may be better addressed with local extra-articular bone grafting techniques to avoid donor site morbidity, disruption of the intact cartilage surface, and replacement with nonlocal cartilage with different thickness and load-bearing properties which does not integrate to the adjacent native cartilage.…”