The clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum of young athletes

• Published in: Journal of shoulder and elbow surgery 2011-07, Vol.20 (5), p.813-818
• Main Authors: Ovesen, Janne, MD, PhD, Olsen, B.S., MD, PhD, Johannsen, H.V., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Athletes; autologous osteochondral mosaicplasty; Biological and medical sciences; Cartilage, Articular - surgery; Diseases of the osteoarticular system; Elbow Joint - surgery; Epiphyses - transplantation; Female; Femur - transplantation; Follow-Up Studies; Humans; humeral capitellum; Humerus - transplantation; Male; Medical sciences; Orthopedics; Osteochondritis dissecans; Osteochondritis Dissecans - etiology; Osteochondritis Dissecans - physiopathology; Osteochondritis Dissecans - surgery; Range of Motion, Articular; Retrospective Studies; Transplantation, Autologous; Treatment Outcome; Vascular bone diseases; Young Adult
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.09.001

Background The purpose of this study was to evaluate the clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum. Materials and methods Between 2003 and 2007, 10 patients (6 female and 4 male patients), with a mean age at surgery of 18 years (range, 13 to 27 years), with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The surgical technique involves transplanting small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyle at the level of the patellofemoral joint to the defect of the capitellum. At a mean follow-up of 30 months, all elbows were assessed with the Mayo Elbow Performance Score and a modified functional elbow score (Constant). Results Postoperative radiographs and control magnetic resonance imaging/computed tomography images showed incorporation of the subchondral cortex in all patients. All but 2 patients were completely pain free after surgery. Of the patients, 8 (80%) had no reduction in range of motion. By use of the Mayo Elbow Performance Score, the injured elbow had a preoperative mean score of 71 points (range, 55 to 85 points) and increased significantly to a mean score of 93.5 points (range, 85 to 100 points) postoperatively ( P = .0005, paired t test). The nonoperative elbows had a mean score of 100 points, whereas the operated elbows had a mean score of 93.5 points. The functional elbow score showed a mean difference of 7.5 points between the operated and nonoperative elbows. No infection or neurologic deficit developed after surgery in any case. Conclusions Autologous osteochondral mosaicplasty for advanced lesions of capitellar osteochondritis dissecans can provide satisfactory clinical and radiographic results.