2015 ISAKOS Biennial Congress ePoster #504

Arthroscopic Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Capitellum

Hiroto Kumagae, MD, Onga, Fukuoka JAPAN
Soshi Uchida, MD, PhD, Kitakyushu, Fukuoka JAPAN
Akinori Sakai, MD, PhD, Kitakyushu, Fukuoka JAPAN

Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, JAPAN

FDA Status Not Applicable

Summary: We demonstrated surgical technique of entirely arthroscopic osteochondral autgraft transplantation for patients with osteochondritis dissecans and retrospectively investigated early clinical outcomes following this procedure.

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Abstract:

Background

Osteochondral autograft transplantation(OAT) is widely utilized for osteochondrotis dissecanse (OCD) of humeral capitellum.

Purpose

The aim of this study was to demonstrate fully arthroscopic OAT and to investigate clinical outcome following this approach.

Materials And Methods

Between 4/2009 and 3/2013, 11 patients with elbow OCD were enrolled in this study and were operated on by a single surgeon (S.U). One was lost for follow-up. Ten cases that remained, all male, were evaluated. The average age was 13.9 years old (ranged 11- 16) at the time of surgery. The mean follow-up periods are 20.3 months (range 7 to 37). All patients had dominant side affected. In all cases, the osteochondral plug grafts were harvested from the ipsilateral lateral femoral condyle fully arthroscopically, and transplantation to OCD lesions at capitellum was performed also arthroscopically. Data were collected from medical records including age, sex, position of the baseball, symptom, range of motion (ROM) and situation of return to baseball. Elbow function was assessed before and after surgery using the Timmerman and Andrews score. According to the classification of the lesion site, 8 patients were extensive lateral type, and 2 patients were central type. MRI and CT were used to assess the stability of the osteochondral fragment.

Results

According to International Cartilage Repair Society (ICRS) classification , our arthroscopic findings were classified as grade III in 2 cases, grade IV in 8 cases. The numbers of the osteochondral autograft were between from 1 to 3 (mean 1.7), and the diameter of the grafts were various for the size of OCD. The mean flexion degree improved significantly from 112.5 ±16.2 degrees to 129.0 ±14.5 degrees (p= 0.043) and extension improved significantly from -19.0 ±12.9 degrees to -7.5 ± 9.2 degrees (P= 0.052) . Timmerman and Andrews score also improved significantly from 123.5±29.0 to 188.5±15.9 (P= 0.000). Intervel throwing program was allowed at 6.3 months (5 to 8) after surgery. 9 of 10 patients were free from pain. The mean average of bone union based on plain radiograph and CT was 3.3 months, and they had returned to same level. The remaining one case had a hypertrophic change of the radial head and osteoarthritic change of radiocapitellar joint. He returned to lower level of baseball activity after 9 months after surgery.

Conclusion

Arthroscopic OAT is less invasive and can provide significantly beneficial clinical outcomes to adolescent baseball players with humeral capitellar OCD.