title: Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum.
abstract: BACKGROUND
  Advanced-stage osteochondritis dissecans of the capitellum affecting the lateral wall may result in osteoarthritis, and suitable treatment is needed to avoid permanent deformation and impaired function. We aimed to assess postoperative outcomes of costal osteochondral autograft for treatment of this condition.
  
  
  METHODS
  We included 22 young overhead athletes (mean age, 13.9 years) with advanced osteochondritis dissecans of the humeral capitellum who underwent costal osteochondral autograft. All patients had elbow pain and wide-range articular cartilage lesions. We evaluated clinical and radiographic outcomes at a mean follow-up of 27 months (range, 12-77 months).
  
  
  RESULTS
  All patients achieved rapid functional improvement and returned to their former sports activity levels. The baseball players were able to play catch within 62 to 164 days (mean, 107 days) and returned to full pitching activity within 123 to 339 days (mean, 226 days). We assessed mean elbow function by the clinical rating system of Timmerman and Andrews and the Japanese Orthopaedic Association sports score; the scores improved from 121.5 and 53.7 points preoperatively to 169.2 points and 86.1 points, respectively, at the time of follow-up. Four patients required additional minor surgical procedures, including screw removal, loose body removal, and shaving off of spur formation. No patient showed obvious radiographic changes of osteoarthritis. All patients were satisfied with the final outcomes and had good functional recovery.
  
  
  CONCLUSIONS
  Costal osteochondral autograft gave satisfactory results for advanced osteochondritis dissecans of the humeral capitellum with extensive lesions affecting the lateral wall.
authors.affiliation: Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan. Electronic address: nissieparadise@pure.ocn.ne.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Nishinaka
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tsutsui
authors.affiliation: Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Uehara
authors.affiliation: Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Nagai
authors.affiliation: Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Atsumi
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000601:surgery; D001484:Baseball / Q000293:injuries; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation; D002648:Child; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D010008:Osteochondritis Dissecans / Q000601:surgery*; D012272:Ribs / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Osteochondritis dissecans of the humeral capitellum; autograft transplantation; baseball; costal osteochondral; surgical treatment; throwing elbow