Osteochondral Transplantation to Treat Osteochondral Lesions in the Elbow

Author(s): Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff A

Source: Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff A

Summary:

This retrospective review of seven patients treated with osteochondral autograft for osteochondral lesions of the capitellum in five patients, trochlea in one patient and radial head in one patient were reviewed at an average follow up of fifty-nine months.  The average age at the time of surgery was seventeen years (range, fifteen to twenty-one years).  All patients had complete detachment of the articular fragment with failure of nonoperative treatment after more than six months or failure of a previous surgery in two patients.  The average diameter of the defect was 9.7 millimeters (range, 9 to 11 millimeters).  The osteochondral autograft was harvested from the nonweightbearing distal femur via a small lateral parapatellar arthrotomy using an OATS device.  Open approach to the elbow was performed via the Kocher interval with some patients requiring complete release of the lateral collateral ligament.  At final follow up, the Broberg and Morrey score improved from a mean of 76 to 98 and pain scores were significantly reduced.  The mean elbow extension lag of 5 degrees was reduced to 0 degrees postoperatively.  Elbow flexion loss of 13 degrees was completely relieved in all patients postoperatively.  Plain radiographs revealed no degenerative changes or signs of osteoarthritis.  MRI scans showed graft viability and a congruent chondral surface in all seven patients.  There was no donor site morbidity at one year postoperatively.  One patient reported mild pain during sports with high impact loads for the first postoperative year then became asymptomatic.  All patients returned to sports and did not complain of restrictions in activities of daily life, and all patients were satisfied and would undergo the procedure again.

There have been three previous studies over the past six years reviewing the results of osteochondral grafting for osteochondritis dissecans of the capitellum in a total of 22 patients.  This is the first study to review its use in an older population of patients with osteochondritis dissecans about the elbow which generally have poor outcomes.  However, these patients at an average of five years had no evidence of arthritis, restoration of full motion, no pain and return to full activities.  Considering the conventional treatment of osteochondritis dissecans in the older patient with arthroscopic removal of loose bodies, debridement, micro-fracture, and/or subchondral drilling produce less satisfactory long-term results in older individuals, this treatment which is much more commonly used in larger joints including the knee may have long-term advantages.  We will need additional data to support the conclusions of this paper as the results presented are almost too good to understand.  Furthermore, when the collateral ligament needs to be released for exposure, which is more common than not to subluxate the radial head and adequately expose the capitellum, one must not underestimate the difficulty and morbidity of this procedure.

 

Elbow, Osteochondritis, Dessicans, Capitellum, Humerus, Cartilage


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