Cylindrical Costal Osteochondral Autograft for Reconstruction of Large Defects of the Capitellum Due to Osteochondritis Dissecans: Surgical Technique.

INTRODUCTION

We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans.

STEP 1 PREPARE AND POSITION THE PATIENT: Mark the ipsilateral (fifth or sixth) rib.

STEP 2 EXCISE/DEBRIDE THE LESION AND CREATE A CYLINDRICAL HOLE: Debride necrotic fibrous tissue completely.

STEP 3 ELEVATE THE COSTAL OSTEOCHONDRAL JUNCTION: Elevate the graft carefully from the periosteum and perichondrium to avoid damage to the pleura.

STEP 4 PREPARE THE OSTEOCHONDRAL AUTOGRAFT: Shape the harvested osteochondral junction like a cone about 18 mm in height, including a 5-mm-high cartilage cap.

STEP 5 PLACE THE GRAFT INTO THE DEFECT AND CLOSE: After packing the grafts, shape and contour the cartilage surface to fit the radial head using a scalpel.

STEP 6 POSTOPERATIVE TREATMENT: Most patients are able to perform normal daily activities in a few days or a week, but they are not allowed to play sports for three months.

RESULTS

Between 2006 and 2010, we performed this operation in forty-three patients with severe osteochondritis dissecans of the humeral capitellum, and twenty-six cases were followed for more than twenty-four months12.

WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.