Capitellar Osteochondritis Dissecans Lesion Treated With Bioabsorbable Pin, Extracellular Matrix Cartilage Allograft, and Intraosseous Bioplasty: A Case Report.

Abstract

Capitellar osteochondritis dissecans (OCD) is a painful and debilitating condition, most often seen in adolescent overhead athletes and gymnasts. Treatment options for unstable capitellar OCD lesions include fragment fixation, autologous chondrocyte implantation, osteochondral autograft, fragment debridement, and drilling of the lesion. While many current surgical techniques yield suboptimal outcomes, this case demonstrates a novel technique for treating an unstable capitellar OCD lesion with associated subchondral cyst in a 14-year-old female patient. This technique combines bioabsorbable pin fixation and allograft cartilage extracellular matrix with intraosseous bioplasty to restore the articular surface and subchondral support. A lateral approach to the elbow was used to create a reamed window in the capitellum, allowing access to the cystic defect. The osteochondral fragment was fixed with a poly-L-lactide acid pin, and the defect was backfilled using demineralized bone matrix mixed with bone marrow aspirate. The residual cartilage lesion was filled with extracellular matrix cartilage allograft. The graft was contained in the lateral window with fibrin glue. At 4-month follow-up, the patient displayed full elbow range of motion with no pain. At 6-year follow-up, magnetic resonance imaging showed a well-healed capitellum with normal contour and signal of the repaired cartilage. This case demonstrates a novel technique for treating OCD lesions of the capitellum with durable clinical and radiographic success.