[Bone-cartilage transfer for osteochondritis dissecans of the humeral capitellum].

IF 1 4区医学 Q3 ORTHOPEDICS

Operative Orthopadie Und Traumatologie Pub Date : 2024-08-01 Epub Date: 2024-07-29 DOI:10.1007/s00064-024-00848-8

Alexander Klug, Matthias Sauter, Reinhard Hoffmann

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引用次数: 0

Abstract

Objective: Treatment of focal cartilage defects of the humeral capitellum with autologous bone-cartilage cylinders to prevent development of arthritis of the elbow joint.

Indications: High-grade, unstable lesions (> 50% of the capitellum, grade III-IV according to Dipaola), including those involving the lateral edge of the capitellum and with a depth of up to 15 mm.

Contraindications: Stable lesions and generalized osteochondritis of the capitellum (including Panner's disease), as well as a relative contraindication for lesions > 10 mm, as the largest punch has a maximum diameter of 10 mm.

Surgical technique: Arthroscopy of the elbow joint, transition to open surgery. First, the size of the cartilage defect in the capitellum is determined. Then, one (or several) osteochondral cylinders (OATS Arthex) are removed, which as far as possible completely encompass the defect zone. Corresponding intact bone-cartilage cylinders are obtained from the ipsilateral proximal lateral femoral condyle, each with a 0.3 mm larger diameter via an additive miniarthrotomy. The "healthy" cylinders are then inserted into the defect zone in a "press fit" technique.

Postoperative management: An upper arm cast in neutral position of the hand for 10-14 days, simultaneously beginning physiotherapy (active-assisted movements) and lymphatic drainage. As soon as painless range of motion (ROM) is restored (goal: by week 6), isometric training can be started. Resistance training starts from week 12. Competitive sports are only recommended after 6(-8) months.

Results: The current state of research on the surgical treatment of OCD of the humeral capitellum using autologous osteochondral grafts shows mostly promising results. A recent meta-analysis of 24 studies reports a significantly higher (p < 0.01) rate of return to sports (94%) compared to fragment fixation (64%) or microfracture and debridement (71%) [41]. However, the increased donor-site morbidity must be taken into account (ca. 7.8%).

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[骨软骨移植治疗肱骨岬骨软骨炎】。］

目的用自体骨-软骨圆柱体治疗肱骨岬局灶性软骨缺损，防止肘关节发生关节炎：适应症：高级别不稳定病变（超过髌骨的50%，根据Dipaola标准为III-IV级），包括累及髌骨外侧边缘且深度达15毫米的病变：禁忌症：髌骨的稳定病变和全身性骨软骨炎（包括潘纳氏病），以及病变大于 10 毫米的相对禁忌症，因为最大打孔器的最大直径为 10 毫米：肘关节镜手术，向开放手术过渡。首先，确定髌骨软骨缺损的大小。然后，取出一个（或多个）骨软骨圆柱体（OATS Arthex），尽可能完全覆盖缺损区。从同侧股骨近端外侧髁处获取相应的完整骨软骨圆柱体，通过加法微型关节切开术将每个圆柱体的直径扩大 0.3 毫米。然后采用 "压入 "技术将 "健康 "的骨软骨筒植入缺损区：上臂石膏固定10-14天，保持手部中立位，同时开始物理治疗（主动辅助运动）和淋巴引流。一旦恢复无痛活动范围（ROM）（目标：第 6 周），即可开始等长训练。阻力训练从第 12 周开始。6（-8）个月后才建议进行竞技运动：使用自体骨软骨移植手术治疗肱骨岬 OCD 的研究现状显示，大部分研究结果都很乐观。最近对 24 项研究进行的荟萃分析表明，使用自体骨软骨移植治疗肱骨髌骨 OCD 的疗效显著高于（p

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来源期刊

Operative Orthopadie Und Traumatologie ORTHOPEDICS-

CiteScore

2.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care. The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems. Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.