Restoration versus stimulation: Meta-analysis of osteochondral autograft transplantation and microfracture for osteochondritis dissecans of the capitellum.

OBJECTIVE

Surgical management of osteochondritis dissecans of the capitellum (OCDC) can range from simple arthroscopic debridement to microfracture to osteochondral autograft transplantation (OAT). The current review aimed to pool the data from the published literature and analyse the outcomes of microfracture and OAT in OCDC.

METHODS

Electronic databases of PubMed and Embase were searched from inception to March 31, 2024 following PRISMA 2020 guidelines. The population of interest was patients with OCDC managed surgically by either microfracture or OAT. Studies were included if they had ≥24 months of follow-up. A total of 21 eligible studies (14 OAT, 7 microfracture) involving 452 patients were analyzed.

RESULTS

The search yielded 14 studies that reported on the outcome of OAT and 7 studies on microfracture. 452 patients were included in the review (OAT = 370, Microfracture = 182). There was no statistical difference in the duration of return to sports between the two groups. A statistically significant difference was noted in the number of patients returning to sports in both groups (OAT - 98%, 95% CI 97-100, Microfracture - 78%, 95% CI 61-96). Similarly, a significant difference was noted when comparing the number of patients returning to their original sports in the OAT group (92%, 95% CI 87-96) as compared to the microfracture group (66%, 95% CI 48-84).

CONCLUSION

Early diagnosis and intervention in OCDC have the potential to lead to optimal functional outcomes in the elbow. The indication for a particular surgery depends on the patient's age, skeletal maturity, lesion stability, symptoms as well as vocation. Patients undergoing OAT have a higher statistical chance of returning to their original sports compared to those undergoing microfracture. Long-term studies will help us further understand the natural course of the procedure.

LEVEL OF EVIDENCE: III.