Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years’ Follow-up

Abstract

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. Purpose/Hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years’ follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: –17° to 0°; group 2: –18° to −6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. Conclusion: No differences were observed in clinical and radiographic outcomes between patients underoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years’ follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.

Elbow Arthroscopy

“…The amount of bone on the posterior aspect of the cartilage fragment may be predictive as to whether the fragment can be arthroscopically repaired. Based on arthroscopic evaluation, excision of an unstable/nonviable osteochondral fragment of the capitellum with microfracture vs. arthroscopic fixation of viable fragments may be performed 13,14 (Figs. 11 through Fig.…”

Osteochondritis dissecans of the elbow: recent evolution of pathogenesis, imaging, and treatment modalities

“…Surgical treatment is principally recommended to the patients who have persistent pain, locking phenomenon, severe restriction of elbow motion, fragment displacement, wide gap between the progeny fragment and the parent bone, irregular contour or defect of the articular surface, and T2 high signal interface through the articular cartilage. 46 , 71 , 84 Surgical procedures include arthroscopic removal of the lesion with or without drilling and microfracture, 5 , 8 , 34 , 50 , 97 fragment fixation, 18 , 22 , 44 , 65 , 64 , 95 , 101 autologous chondrocyte implantation, 27 osteochondral autograft transplantation (OAT), 1 , 15 , 25 , 42 , 45 , 48 , 62 , 72 , 73 , 74 , 76 , 77 , 78 , 96 wedge osteotomy, 33 osteochondral allograft, and various novel techniques. 47 , 59 , 60 Candidate donor sites for OAT include the non-weight-bearing area of the lateral femoral condyle and the transitional area between the rib and its associated cartilage.…”

“… 47 , 59 , 60 Candidate donor sites for OAT include the non-weight-bearing area of the lateral femoral condyle and the transitional area between the rib and its associated cartilage. 1 , 15 , 25 , 42 , 45 , 48 , 60 , 73 , 74 , 76 , 77 , 78 , 96 , 101 …”

Adolescent elbow osteochondral lesions following prior elbow fracture pinning

“…14 While the age of the patient, size and stability of the lesion, level of overhead activity, and surgeon preference help delineate surgical treatment, stud ies directly contrasting treatment arms have found similar results among operative cohorts. 15,16 While the specific cause of elbow osteochondral lesions may be multifactorial, there is increasing interest in identi fying risk factors for its development. The purpose of this study was to investigate the association between patients requiring surgery for elbow osteochondral lesions and prior supracondylar humerus or lateral condylar pinning, including evaluating patient demographics, imaging find ings, and treatment outcomes.…”

“… 14 While the age of the patient, size and stability of the lesion, level of overhead activity, and surgeon preference help delineate surgical treatment, studies directly contrasting treatment arms have found similar results among operative cohorts. 15 , 16 …”