title: Outcomes of an open autologous osteochondral plug graft for capitellar osteochondritis dissecans: time to return to sports.
abstract: BACKGROUND
  Autologous osteochondral plug grafts have been used for capitellar osteochondritis dissecans (OCD), and good clinical results have been described. However, little is known about the optimal timing of return to sports.
  
  
  OBJECTIVE
  To investigate the clinical outcomes of open autologous osteochondral plug grafts for capitellar OCD and to address the timing of return to sports.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Thirty-three male patients with a mean age at the time of surgery of 13.6 years (range, 11-17 years) and with advanced lesions of capitellar OCD underwent a procedure using open autologous osteochondral plug grafts. All patients played baseball, and the lesion affected their throwing side. Thirteen lesions were arthroscopically classified as International Cartilage Repair Society (ICRS) OCD III and 20 lesions as ICRS OCD IV. The mean size of the lesions (sagittal × coronal) was 16 × 14 mm. One to 3 osteochondral plug grafts, with a mean diameter of 7 mm (range, 5-9 mm), were harvested from the lateral femoral condyle and transplanted to the defects. Patients were allowed to begin throwing after 3 months and to return to sports after 6 months. The mean follow-up was 28.4 months (range, 12-76 months), during which elbow pain, Timmerman and Andrews scores, return to sports, and radiographs were evaluated.
  
  
  RESULTS
  After surgery, 30 patients (91%) had no elbow pain, and 3 patients (9%) had occasional mild throwing pain. The mean total arc of elbow motion increased significantly from 116° to 133° (P < .05). The mean Timmerman and Andrews score improved significantly from 143 to 190 (P < .05). All except 2 patients returned to a competitive level at which they had previously played after a mean of 6.9 months (range, 6-14 months). One patient chose another sport, and another retired from baseball after high school graduation. All patients achieved graft incorporation, and there was no postoperative enlargement of osteophytes on radiographs. One patient had mild anterior knee pain at the donor site during exercise. The remaining patients had no knee pain. The mean Lysholm score was 99.8.
  
  
  CONCLUSIONS
  The results of this study indicate that an open autologous osteochondral plug graft allows a return to the previous competitive level of throwing by a mean of 7 months postoperatively.
authors.affiliation: Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan masamaruyama@med.id.yamagata-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Maruyama
authors.affiliation: Center for Hand, Elbow and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Takahara
authors.affiliation: Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satake
authors.affiliation: Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Takagi
mesh_terms: D000293:Adolescent; D001182:Arthroscopy; D054874:Athletic Performance; D001484:Baseball; D016025:Bone Transplantation / Q000379:methods*; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery*; D002648:Child; D004551:Elbow Joint / Q000473:pathology / Q000601:surgery*; D005269:Femur / Q000637:transplantation*; D006801:Humans; D008297:Male; D010008:Osteochondritis Dissecans / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: baseball; elbow; operation; osteochondral graft; osteochondritis dissecans; return to sports