Osteochondral Allograft Transplant for Capitellar Osteochondritis Dissecans: Excellent Patient-Reported Outcome Scores and High Return to Sport at Minimum 2-Year Follow-up

Abstract

Background:

Unstable osteochondritis dissecans of the capitellum (OCD-C) is most commonly treated with debridement and marrow stimulation. This treatment has historically been associated with suboptimal return to high-demand upper extremity sports and persistent elbow pain. Fresh osteochondral allograft transplant (OCAlloT) is an alternative treatment that restores subchondral bone and articular cartilage without the donor site morbidity that is associated with autograft harvest.

Purpose:

To evaluate the outcomes of OCAlloT in pediatric patients with unstable OCD-C ≥10 mm in diameter.

Study Design:

Case series; Level of evidence, 4.

Methods:

A single-center prospective study was performed of pediatric patients younger than 19 years who had unstable OCD-C ≥10 mm in diameter treated with primary fresh OCAlloT using precut osteochondral allograft cores. Postoperative magnetic resonance imaging (MRI) was obtained to assess graft incorporation. Patient-reported outcome (PRO) scores were obtained preoperatively and then annually after surgery. Minimum follow-up duration was 2 years.

Results:

The study included 28 elbows in 26 patients, mean age 13.5 years (range, 11.3-17.1 years). The most common primary sports were gymnastics and baseball. OCD location was far-lateral in 6 elbows (21%). Mean OCD size was 11 mm in width, 12 mm in length, and 7 mm in depth. Twenty-four elbows (86%) were treated with a single allograft plug. Median OCAlloT size was 11.8 mm in diameter. Mean follow-up duration was 40 months. No infections or graft failures occurred. Two elbows (7%) had a secondary surgery for arthrofibrosis and posterolateral synovial impingement. Postoperative MRI scans were obtained in 19 elbows (68%) and demonstrated a high degree of graft incorporation. All patients had preoperative, 1-year, and 2-year PRO scores, and the 1- and 2-year PRO scores showed significant improvements compared with preoperative PRO scores. A total of 23 elbows (82%) had returned to sports at 1 year, and 27 (96%) had returned to sports at 2 years.

Conclusion:

OCAlloT for treatment of OCD-C was associated with low rates of complications, excellent graft incorporation, high elbow function, patient satisfaction, and overall high rates of return to sports at 2 years.