A Prospective, Randomized Clinical Study of Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondritis Dissecans in the Knee Joint in Children

Author(s): Gudas R, Simonaityte R, Cekanauskas E and Tamosiunas R

Source: J Pediatr Orthop 29(7):741-748, 2009.

Summary:

This article was selected because it is relevant to osteochondritis dissecans about the elbow.  The authors did a prospective randomized clinical study on osteochrondral autologous transplantation (OAT) procedure versus microfracture for the treatment of OCD in the knee joint in children.  A total of 50 children with a mean age of 14 years were included in the cohort.  All children had symptomatic OCD in the femoral condyle of the knee.  The children were than randomized to either OAT or microfracture procedure.  Inclusion criteria included the following: 1) grades 3-4 OCD lesion; 2)  OCD defects between 2 and 4cm squared in area; and 3) age less than 18 years.

The procedures were performed after a preliminary arthroscopic examination.  If the lesion was suitable to be included than randomization was performed.  The average surgical time was 49 minutes in OAT and 28 minutes in the microfracture group.  The standard procedures for OAT and microfracture were performed.  The rehabilitation program was identical for both operative groups.

The results show clinical improvement in both cohorts.  However, the International Cartilage Repair Society (ICRS) grading system was superior in the OAT group compared to the microfracture group.  At mean follow-up of 4.2 years, the OAT group was far superior to the microfracture group.  Eighty-three percent of patients in the OAT had an excellent or good results compared to 63% in microfracture group.  The microfracture group showed significant deterioration over time.  MRI evaluation showed excellent or good repairs in 91% after OAT, compared with 56% after microfracture.  

This prospective randomized study provides clinical and radiographic evidence that indicates that OAT is superior to microfracture regarding the treatment of osteochondritis dissecans in the knee.  Even though there were good results in both groups, the OAT procedure stood the test of time.  The question for the upper extremity surgeon is would a similar result be obtained in osteochondritis dissecans about the elbow?  Certainly, the results of microfracture for OCD about the elbow have not been uniform and possibly an OAT procedure should be considered for those lesions that fulfill these criteria—especially those that are not “contained” and involve the lateral rim of the capitellum.  However, it must be emphasized that the exposure and ability to place plugs into the capitellum is much more difficult than the knee due to congruent nature of the radiocapitellar joint.  Furthermore, as the elbow is non-weight bearing compared to the knee, the results may not be directly applicable.