Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD)

Abstract

Purpose The primary outcomes are the evaluation and quantiication of pain relief and improvement in range of motion after OAT in OCD. The secondary outcomes are: resuming of sport activities, evaluation of the ADL recovery rate and subjective evaluation of the quality of life improvement. Methods Nine patients, afected by an unstable and non-acute OCD lesion of the capitulum humeri, have been treated by the same surgeon. The patient mean age was 22.4 (16-45 years). All subjects were treated with the same surgical technique (arthroscopic OAT from the same side knee, a single cylinder of 6.5-9 mm in diameter) and underwent the same rehabilitation. The mean follow-up was 48 months (30-52 months). The authors documented the clinical assessment of each patient and carried out a questionnaire which included the VAS scale, MEPS Score and Quick DASH score. Patients were asked for MRI and radiographs pre-and post-operatively at follow-up. ResultsThe mean range of motion improvement was 17.9° in extension (range 13°-27°) and 10.6° in lexion (range 0°-20°) The VAS mean improvement was 7.1 (range 6-8) and the mean post-op value 0.6 (range 0-3). The MEPS score mean postoperative value was 98.3 (range 85-100). The Quick-DASH mean post-operative value was 2.5 (range 0-9.1) with a mean improvement of 41.4 points (range 36.4-47.7 points). All patients resumed sports in 6 months post-operatively. Conclusions The autologous transplant of an osteochondral plug is a safe and promising procedure. Despite being more demanding, the arthroscopic approach is a valuable tool if the surgeon aims to reduce the invasiveness of the procedure, with all the consequent advantages. Level of evidence IV Retrospective case series, therapeutic study.

Arthroscopic Evaluation and Management of Osteochondritis Dissecans

“…When lateral column involvement is more than 6 mm, OAT is strongly suggested [4,9]. OAT is the only technique that can address at the same time the articular cartilage and the subchondral bone pathology [21][22][23]. The plug can be customized to match the recipient site in shape, but not in cartilage thickness.…”

Advances and future trends in elbow arthroscopy

“…Arthroscopic OAT for the capitellum has encouraging midterm results. [54] Donor site morbidity is a drawback of any OAT procedure.…”

Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G)

“…The physician-administered Mayo Elbow Performance Score (MEPS), also known as the Mayo Elbow Performance Index [ 13 ], is currently the most commonly used outcome measure of elbow impairments in clinical trials worldwide [ 14 ]. Despite the broad international utilization of the MEPS [ 14 – 19 ], it is described as not being adequately validated [ 25 ] and only a relatively small number of translations, and cross-cultural adaptations have been performed.…”