Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes.
BACKGROUND
Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans.


METHODS
From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery.


RESULTS
Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112 degrees +/- 17 degrees preoperatively to 128 degrees +/- 12 degrees postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 +/- 23 points preoperatively to 191 +/- 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient.


CONCLUSIONS
The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.
Iwasaki
Norimasa
N
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan. niwasaki@med.hokudai.ac.jp
Kato
Hiroyuki
H
Ishikawa
Jyunichi
J
Masuko
Tatsuya
T
Funakoshi
Tadanao
T
Minami
Akio
A
D000293:Adolescent; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000637:transplantation; D004551:Elbow Joint; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D010008:Osteochondritis Dissecans / Q000601:surgery*; D016896:Treatment Outcome