Osteochondral autograft transfer for capitellar osteochondritis dissecans in high-level adolescent athletes

Abstract

Background

Osteochondritis dissecans (OCD) of the capitellum is a condition that predominantly affects high-performing adolescent athletes engaged in repetitive overhead motion and can lead to pain and mechanical symptoms that can interfere with the ability to perform in sports. Optimal surgical management of large OCD lesions remains inadequately studied. Prior studies have shown good short-term outcomes with the use of osteochondral autograft transfer (OAT). This study's primary objective is to evaluate the long-term outcomes of adolescent athletes undergoing OAT procedures for capitellar OCD.

Methods

We retrospectively identified 28 patients with large (≥1 cm²) unstable capitellar OCD lesions who underwent OATs from the ipsilateral knee. The average age at the time of surgery was 14.95 years (range, 11-22 years). Time to return to play, post-operative and final level of play, Disabilities of the Arm, Shoulder and Hand (DASH) and Sport-Specific DASH questionnaires, pre-operative and post-operative elbow range of motion, post-operative elbow Single Assessment Numeric Evaluation score, and radiographic outcomes were collected and analyzed. Twenty patients were available for evaluation at an average of 62.4 months of follow-up (range 6 to 164.5 months). Chart review was conducted for the remaining patients.

Results

The average return to play timeline was 6.28 months (range, 3-13 months). The return to sport rate was 95%. Eighty percent of pitchers returned to pitching, all throwing by an average of 4 months. The average overall DASH score was 3.79 (95% confidence interval [CI]: 1.83–5.75), and the average Sport Specific DASH score was 7.11 (95% CI: 0.45–14.78). Elbow range of motion significantly improved, with improvement in flexion from a pre-operative average of 130.3° to 140.9° post-operatively (P < .001) and improvement in extension from a pre-operative average of 16.1° to 2.3° post-operatively (P < .001). Average post-operative elbow Single Assessment Numeric Evaluation scores collected from 12/20 patients were 85.8 (range, 60-100). Osseous integration of the graft site was complete in 24 of the patients by the 12-week post-operative visit.

Conclusion

Treatment of large, unstable OCD lesions of the capitellum in adolescent athletes is safe, allows for a high rate of return to sport, and has good clinical outcomes with long-term follow-up.