Summary

The use of a coronoid or radial head osteo-chondral allograft could be a valid possibility to resolve complex recurrent instabilities of the elbow with coronoid process deficiency, without incurring the described donor site morbidities. This is a retrospective analysis of the clinical and radiological results objectified at medium-term follow-up.

Abstract

Background

Chronic coronoid deficiency is a challenging condition that can occur subsequent to coronoid fracture malunion/nonunion or to coronoid post-traumatic hypoplasia. Several surgical options have been described to reconstruct the coronoid using bone (bicortical and tricortical iliac crest) or osteochondral grafts (olecranon tip, radial head, coronoid). We hypothesized that both coronoid and radial head osteochondral allografts could restore elbow stability and congruity.

Methods

In 8 consecutive cases affected by recurrent complex instability for a coronoid deficiency the coronoid was reconstructed using an osteochondral fragment from a frozen coronoid (4 cases) or radial head (4 cases) allograft. The lateral collateral ligament was reconstructed in 6 patients, the medial collateral ligament in 2 patients. The patients were followed-up for a mean of 48 months, asked to answer three types of validated scales: VAS score for pain, Quick-DASH score and MEPS score for subjective and objective functional outcomes. A CT-scan was also performed in all the patients to evaluate the healing of the graft.

Results

At a mean follow up of 48 months (18-122), all the patients achieved a significant improved elbow, with at least a functional range of motion. CT scans showed the union of the graft, without evidence of graft resorption or degenerative changes. One of the patients treated with a radial head graft presented persistent ulnar nerve symptoms with a mild elbow instability. 7 patients achieved a congruent and stable joint, without any pain in 6 cases.

Conclusion

The results of our case series show that both frozen allografts harvested from coronoid or radial head can be used to treat a chronic coronoid deficiency. The healing of the graft in all cases encourage the use of an osteochondral allograft, that if appropriately shaped, anatomically positioned and strongly fixed has shown rapid graft healing without subsequent resorption.