Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow.

UNLABELLED: The treatment of large, advanced osteochondritis dissecans of the elbow is controversial. To ascertain whether better results could be obtained using osteochondral autografts, we retrospectively reviewed the results in 10 young athletes (mean age, 14.3 years; range, 12-17 years) who were followed up for a mean of 25.5 months (range, 18-45 months). After abrasion of the fragments, cylindrical osteochondral bone plugs were transferred from a lateral femoral condyle. They were assessed clinically by the Japanese Orthopaedic Association elbow score and radiologically by radiocapitellar congruity. All patients achieved bony union in 3 months. The average Japanese Orthopaedic Association score was 80.6 points before surgery and improved to 93.8 points at followup. The average percentage of radiocapitellar congruity was 35.7% before surgery and improved to 64.2% at followup. Clinical and radiologic results were excellent in eight patients and poor in two. Poor results may be dependent on preexisting osteoarthritis and technical difficulty related to the location of the lesion. In eight patients, a durable load-bearing elbow was obtained with this procedure, which made hyaline-like cartilage resurfacing with healthy subchondral bony support possible. Osteochondral autograft is a reasonable surgical option for an advanced lesion of osteochondritis dissecans of the elbow, although long-term followup is needed to know whether the early results persist.

LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.