Bone-peg grafting for osteochondritis dissecans of the humeral capitellum.
To review the outcome of bone-peg grafting for osteochondritis dissecans (OCD) grade II lesions of the humeral capitellum.



Records of 10 male adolescent baseball players aged 10 to 15 (mean, 12.3) years who underwent bone-peg grafting for OCD grade II lesions of the humeral capitellum of the dominant arm were reviewed. The mean time from symptom onset to presentation was 11 (range, 1-36) months. The mean duration of conservative treatment was 5 (range, 1-25) months. The mean time from symptom onset to surgery was 17 (range, 3-39) months; it was >6 months in 6 patients. The mean size of the lesions was 13x14 mm. Patients were assessed for elbow pain, range of elbow and forearm motion, Timmerman- Andrews elbow score, return to sports activity level, and radiographic evidence of healing, osteoarthritic changes, and radial head hypertrophy.



The mean follow-up period was 25 (range, 10-52) months. Postoperatively, elbow pain was absent in 6, mild in 2, and moderate in 2 patients. The mean range of elbow motion changed from 136º to 139° (p=0.80). The mean Timmerman-Andrews elbow score improved from 163 to 189 (p=0.014); it was excellent in 7, good in 2, and fair in one patient. The mean extent of lesion healing was 71% (range, 33-100%). Five patients achieved complete healing after a mean of 5.2 (range, 5-6) months and returned to sports at a competitive level. The other 5 achieved partial healing of 33 to 56% (mean, 41%) that occurred laterally but not medially. Two of them returned to sports at a competitive level: one changed the throwing side and another had radial head hypertrophy. The remaining 3 underwent arthroscopic debridement of the unhealed lesion at 5, 10, and 15 months. One patient developed secondary osteoarthritis and further underwent costal osteochondral autografting 10 months later. None of the 5 patients with partial healing versus 4 of the 5 patients with complete healing underwent surgery within 6 months of symptom onset. All 3 patients with a dot at the interface versus 2 of the 6 patients with a line at the interface between the fragment and the lesion on MRI had complete healing.



Bone-peg grafting is a viable option for OCD grade II lesions of the humeral capitellum when performed within 6 months of symptom onset and when the interface between the fragment and the lesion appears as a dot (rather than a line) on MRI.
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Japan & Center for Hand, Elbow and Sports Medicine, Izumi Orthopedics Hospital, Japan.
M
M
Maruyama
Center for Hand, Elbow and Sports Medicine, Izumi Orthopedics Hospital, Japan.
M
M
Harada
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Japan.
H
H
Satake
Center for Hand, Elbow and Sports Medicine, Izumi Orthopedics Hospital, Japan.
U
U
Tomohiro
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Japan.
M
M
Takagi
Center for Hand, Elbow and Sports Medicine, Izumi Orthopedics Hospital, Japan.
M
M
Takahara
D000293:Adolescent; D001265:Athletic Injuries / Q000601:surgery; D001484:Baseball / Q000293:injuries; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D010008:Osteochondritis Dissecans / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
baseball; bone transplantation; elbow; osteochondritis dissecans