2015 ISAKOS Biennial Congress ePoster #506

The Results of a Single Large Osteochondral Graft Transfer for Large Lateral Lesion of Osteochondritis Dissecans of The Humeral Capitellum

Norihiro Sasaki, Hirosaki, Aomori JAPAN
Eiichi Tsuda, Prof., Hirosaki, Aomori JAPAN
Yuji Yamamoto, MD, Hirosaki, Aomori JAPAN
Shugo Maeda, MD, 八戸市, aomoriken JAPAN
Takuya Naraoka, MD, Fujinomiya, Shizuoka JAPAN
Yuka Kimura, MD, PhD, Hirosaki, Aomori JAPAN
Yasuyuki Ishibashi, MD, Hirosaki, Aomori JAPAN

Hirosaki University, Hirosaki, Aomori, JAPAN

FDA Status Not Applicable

Summary: A single large osteochondral graft transplantation for the lateral widespread type of capitellar OCD showed good clinical results.

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Abstract:

Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder in adolescents who participate in sports that repetitively stress the elbow, particularly baseball. Osteochondral autografts (mosaicplasty) have recently become popular for treating unstable lesions. Reconstructing the tight curvature of the capitellum with mosaicplasty requires advanced technique and the outcome is often unsatisfactory. Even if the articular surface for lateral widespread type of capitellar OCD is reconstructed by mosaicplasty, the base of the graft columns would overlap and stability would be compromised because of covering large defect lesion and defecting lateral wall of capitellum. We report an alternative strategy to mosaicplasty, using a single large osteochondral graft for lateral widespread type, and evaluate its short-term clinical outcome.

Methods

The subjects were twenty young male baseball players (mean age, 13.9 years) with lateral widespread type of unstable capitellar OCD. All patients received a single large osteochondral graft transplantation. Mean follow-up period after surgery was 25.4 ± 9.7 months. Graft harvest and graft insertion was performed by open surgery. The single 10 mm diameter cylindrical osteochondral graft was harvested from the lateral side of the patellofemoral joint. The graft was inserted into the center of the lesion with the subchondral defect remaining around the graft. The graft cap was accommodated to the surrounding articular surface of the lesion by direct vision. After graft insertion, internal and external rotations with the elbow flexed were performed to check for congruency of the radiohumeral joint. After surgery, range of motion exercise was started immediately if the graft was deemed stable. MRI evaluation was performed three months postoperatively. If progress of engraftment was good, gentle throwing was initiated and full throwing was permitted at 4 to 6 months. Preoperative and postoperative Timmerman-Andrews score, range of motion, and plain radiograph and MR imaging were used to evaluate the clinical outcome. All patients were followed for more than one year after operation.

Results

Mean preoperative Timmerman-Andrews score was 131.2 ± 22.0 points. Mean preoperative extension and flexion degrees of elbow were -14.1 ± 17.7° and 126.2 ± 10.5°, respectively. At final follow-up, the Timmerman-Andrews score significantly improved to 186.8 ± 13.5 (p<0.001). Extension and flexion degrees of elbow also significantly improved to -1.5 ± 6.5° (p<0.001) and 134.4 ± 10.2° (p<0.01), respectively. Four patients had a free body and two of them underwent additional operation to remove it, after which their symptoms disappeared. The remaining two had no symptoms from the free body, therefore, they did not undergo additional surgery. Sixteen out of the twenty patients had smooth articular surfaces and the remaining four had slightly irregular articular surfaces by MRI evaluation. There was no morbidity of the harvest site. Nineteen patients returned to their previous baseball playing levels and one patient switched to bowling.

Conclusion

A single large osteochondral autograft was used for the lateral widespread type of capitellar OCD. This procedure showed good clinical results and made nineteen out of the twenty patients returned previous sports levels.