Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes

Abstract

Background: Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans. Methods: From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery. Results: Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112°± 17°preoperatively to 128°± 12°postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 ± 23 points preoperatively to 191 ± 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient. Conclusions: The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence

Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum

“…4,11,12,17,19,30,31,33,35 In particular, recent mosaicplasty of the knee has been useful in enabling reconstruction of the articular surface through the continuity of the hyaline cartilage and the subchondral bone. 1,7,8,26,34 However, results indicate that despite cartilage implant, it is mainly cancellous bone that causes serious limitations, and because insertion of the lateral wall is surgically difficult in patients with extensive loss, the defective portion may not be completely covered and may result in poor outcomes. 26,34 To date, studies have identified progression to arthritis as an underlying factor of poor outcomes of surgery.…”

“…26 Several studies have followed this approach, and most patients returned to their former sporting activity without progression of degenerative changes. 1,7,8,34 However, unavoidable donor site problems remain a disadvantage. One report showed no adverse effects at the donor site, whereas another described unfavorable donor site problems after mosaicplasty.…”

“…Further, recent reports have described the utility of mosaicplasty for reconstruction of joint surfaces with hyaline cartilage, which has continuity with the subchondral bone, even in patients with complete separation. 1,7,8,26,34 However, in advanced cases with extensive lesions affecting the lateral wall, reports indicate that it is difficult to adequately substitute the defective portion, 26,34 and outcomes may thus be poor. Consequently, such cases have been treated by costal osteochondral autograft transplantation, and there have been many reports of case studies after the 2001 report by Oka and Ikeda.…”

Is there any difference between open and arthroscopic treatment for osteochondritis dissecans (OCD) of the humeral capitellum: a systematic review and meta-analysis

“…Surgery is indicated for patients who fail non-operative treatment and those with unstable lesions [6]. The surgical treatments are variable, including debridement, drilling or micro-fracture, fragment fixation, and osteochondral autograft transplantation [1,[7][8][9][10]. Among them, the debridement with fragment fixation is a time-tested procedure and one of the most widely used methods for surgical treatment of unstable capitellum OCD [11][12][13][14][15].…”

Transplantation of tissue-engineered cartilage for the treatment of osteochondritis dissecans in the elbow: Outcomes over a four-year follow-up in two patients

“…Cartilage resurfacing techniques have become a clinical reality and provided for successful treatment of osteochondral defects. 9,19,21,30 Iwasaki et al 15 consider that these techniques can be effectively applied to unstable OCD lesions with displaced or detached fragment(s) and to failed operative cases.…”