Fresh Osteochondral Allograft Transplantation for the Treatment of Unstable Osteochondritis Dissecans of the Capitellum in the Elbow

Singh, Paramjit; Mirzayan, Raffy

doi:10.1097/bte.0000000000000066

Cited by 5 publications

(6 citation statements)

References 32 publications

(30 reference statements)

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“…An array of surgical treatment options exists, including lesion debridement and/or drilling (open or arthroscopic), 40 internal fixation (open or arthroscopic), 23 osteochondral autograft transfer from the knee or rib, 31 and osteochondral allograft transfer. 42,59 In a 2016 systematic review by Westermann et al, 62 the authors investigated the clinical outcomes and return-to-sport rates after operative management of capitellar OCD lesions in 492 adolescent athletes. The study found a high rate of return to sport, with the highest return to preoperative sport participation after osteoarticular autograft transfer as compared with debridement or fixation.…”

Section: Overuse Injuries Of the Lateral Elbowmentioning

confidence: 99%

“…As a result, there is growing interest in the use of osteochondral allograft transfer in gymnasts, although the literature is insufficient to compare its results with autograft transfer. 36,42,59 Our primary indication for allograft transfer at this time remains patient and family preference to avoid autograft harvest (Figure 3).…”

Section: Overuse Injuries Of the Lateral Elbowmentioning

confidence: 99%

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Overuse Elbow Injuries in Youth Gymnasts

et al. 2021

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Background: Gymnastics is a unique sport that places significant loads across the growing elbow, resulting in unique overuse injuries, some of which are poorly described in the current literature. Purpose: To provide a comprehensive review of the unique overuse elbow injuries seen in youth gymnasts and to provide an up-to-date synthesis of the available literature and clinical expertise guiding treatment decisions in this population. Study Design: Narrative review. Methods: A review of the PubMed database was performed to include all studies describing elbow biomechanics during gymnastics, clinical entities of the elbow in gymnasts, and outcomes of operative and/or nonoperative treatment of elbow pathology in gymnasts. Results: Participation in gymnastics among youth athletes is high, being the sixth most common sport in children. Early specialization is the norm in this sport, and gymnastics also has the highest number of participation hours of all youth sports. As a result, unique overuse elbow injuries are common, primarily on the lateral side of the elbow. Beyond common diagnoses of radiocapitellar plica and osteochondritis dissecans of the capitellum, we describe a pathology unique to gymnasts involving stress fracture of the radial head. Additionally, we synthesized our clinical experience and expertise in gymnastics to provide a sport-specific rehabilitation program that can be used by providers treating surgical and nonsurgical conditions of the elbow and wishing to provide detailed activity instructions to their athletes. Conclusion: Overuse injuries of the elbow are common in gymnastics and include osteochondritis dissecans of the capitellum, radiocapitellar plica syndrome, and newly described radial head stress fractures. A thorough understanding of the psychological, cultural, and biomechanical aspects of gymnastics are necessary to care for these athletes.

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Section: Overuse Injuries Of the Lateral Elbowmentioning

confidence: 99%

Section: Overuse Injuries Of the Lateral Elbowmentioning

confidence: 99%

Overuse Elbow Injuries in Youth Gymnasts

et al. 2021

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“… # References 1-5, 8-10, 12-17, 21, 23-25, 27-30, 32-34, 36, 38-42, 45, 47, 48, 50-54, 56, 60-71, 73, 75-78, 80, 81, 83-85, 87-89, 91…”

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confidence: 99%

Treatment Strategies and Outcomes for Osteochondritis Dissecans of the Capitellum

et al. 2021

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Background: The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject. Purpose: To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment). Results: No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions. Conclusion: Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.

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“…1,2 The population most at risk for developing OCD at the elbow are adolescent athletes participating in year-round upper extremity-sports (ie, gymnastics, baseball). 2,3 Lesions at the elbow primarily affect the capitellum and have an estimated prevalence of 2.2 per 100,000 person years. 4 There are multiple accepted classification systems used to stratify the severity of OCD lesions of the capitellum.…”

mentioning

confidence: 99%

“…2,7,8 Fresh osteochondral allograft transplant (FOCAT) comparatively carries less risk of morbidity and results in similar outcomes at 4-year follow-up. 3,5 A major challenge faced by surgeons performing FOCAT is anticipating graft fit. Poor fit is known to result in poor outcomes such as chronic pain and reduced range of motion.…”

mentioning

confidence: 99%

Optimizing Graft Extraction From the Femoral Condyle for Fresh Osteochondral Allograft Transplantation in Treating Osteochondritis Dissecans of the Capitellum: Best Fit Based on Radius of Curvature

Goldstein¹,

Thompson²,

Robbins³

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Osteochondritis dissecans (OCD) of the capitellum is a common cause of pain and dysfunction in adolescents that engage in repetitive elbow loading. For large, unstable lesions fresh osteochondral allograft transplantation (FOCAT) from the femoral condyle has been described as an effective treatment. Current practice involves significant guesswork in obtaining an appropriately sized graft, with anatomic variations resulting in poor graft fit. No studies currently exist that analyze and identify the best distal femur FOCAT graft site to repair OCD lesions of the capitellum based on the radius of curvature (ROC) and simulated matching. Methods: Computed tomography scans of the elbow were used to estimate the subchondral bone ROC of capitella in adolescents aged 11 to 21 years. The capitellar location used corresponds to the most commonly reported site of OCD lesions in the elbow. Computed tomography scans of the lower extremity were used to estimate the subchondral bone ROC of 4 potential donor femoral condyle grafts. ROC from distinct regions at the posterior section of both the medial and lateral femoral condyles were measured: 2 areas representing 10 mm grafts from the center (MC1 and LC1), and 2 areas estimating 10 mm grafts posterior and adjacent to the physeal scar (MC2 and LC2). Intraobserver and interobserver reliability measurements were preformed to corroborate precision and validate the method. Results: The mean ROC of healthy subchondral bone at the region of the capitellum were OCD lesions most commonly occur was 9.79 ± 1.39 mm. The mean ROC of MC1 was 18.61 ± 2.26 mm. The average ROC of the MC2 was 15.23 ± 1.43 mm. The average ROC of LC1 was 16.47 ± 1.34 mm. The average ROC of LC2 was 18.19 ± 3.09 mm. After 15,000 simulated condyle-tocapitellar site matchings based on these measurements, a good fit graft was achieved at a frequency of 15%. Discussion: No site measured from the femoral condyle demonstrated a subchondral ROC that exactly matched the subchondral ROC of the capitellum at the center location where OCD lesions most commonly occur; of the locations measured, a 10 mm section from MC2 demonstrated the closest match. On the basis of this analysis, extracting a graft from MC2 has the potential to further optimize FOCAT fit to the capitellum. Level of Evidence: Level III.

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Fresh Osteochondral Allograft Transplantation for the Treatment of Unstable Osteochondritis Dissecans of the Capitellum in the Elbow

Cited by 5 publications

References 32 publications

Overuse Elbow Injuries in Youth Gymnasts

Overuse Elbow Injuries in Youth Gymnasts

Treatment Strategies and Outcomes for Osteochondritis Dissecans of the Capitellum

Optimizing Graft Extraction From the Femoral Condyle for Fresh Osteochondral Allograft Transplantation in Treating Osteochondritis Dissecans of the Capitellum: Best Fit Based on Radius of Curvature

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