Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients.
BACKGROUND
Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum.


OBJECTIVE
To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans.


METHODS
Case series; Level of evidence, 4.


METHODS
Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically.


RESULTS
Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball.


CONCLUSIONS
Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan. niwasaki@med.hokudai.ac.jp
Norimasa
N
Iwasaki
Hiroyuki
H
Kato
Jyunichi
J
Ishikawa
Satoru
S
Saitoh
Akio
A
Minami
D000293:Adolescent; D001484:Baseball / Q000293:injuries; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005269:Femur / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000637:transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular; D014182:Transplantation, Autologous; D015599:Trauma Severity Indices; D016896:Treatment Outcome