Osteochondral autologous transplantation surgery (OATS) has been advocated for unstable osetochondritis dissecans (OCD) lesions of the adolescent capitellum
, though limited information is available regarding clinical and radiographic results in North American patients. We hypothesize that single-plug OATS is safe and effective in alleviating pain and restoring function in unstable OCD.
Twenty-eight patients with unstable OCD treated with single-plug OATS were evaluated. Mean age at surgery was 14.2 years; there were 14 males. Etiology of OCD was presumed to be sports participation, including baseball (n=5) and gymnastics (n=11). Indications for surgery included unstable, deep OCD lesions; 2 lesions were uncontained, and 3 patients (11%) had OATS after failed prior surgery. OATS was performed by an anconeus muscle-splitting approach; donor grafts were harvested from the lateral femoral condyle by small arthrotomy. Functional outcomes were quantified using the Timmerman instrument. Median clinical and radiographic follow-up was 6.3 months (range, 5.0 to 27.0 mo) and 5.7 months (range, 5.0 to 26.7 mo), respectively. Furthermore, all patients returned functional questionnaires at a median of 9 months postoperatively (range, 5 to 27 mo).
Of the 26 patients who reported preoperative tenderness, 19 (73%) patients had no tenderness at most recent clinical follow-up (P
=0.02). Of 18 patients with restricted elbow
motion preoperatively, 13 had achieved full range of motion (P
=0.10). Both elbow
flexion and extension improved significantly [flexion: median change (interquartile range)=10 degrees (0 to 10 degrees), P
=0.009; extension: 0 degree (−5 to 0 degrees), P
<0.001). On postoperative magnetic resonance imaging, 86% (P
<0.001) of elbows had restoration of articular congruity and 93% had complete graft incorporation. Objective [median change (interquartile range)=5 degrees (0 to 15 degrees)], subjective [25 degrees (15 to 40 degrees)], and overall [35 degrees (15 to 45 degrees)] Timmerman scores improved significantly (P
=0.001, <0.001, and <0.001, respectively). Of the 13 patients with >6 months follow-up, 9 patients (69%) had returned to their primary sport (P
=0.27) and 100% had returned to general sports participation. There were no postoperative complications. At final follow-up, all donor knees were asymptomatic with full motion and strength.
Single-plug OATS is safe and effective in improving pain and elbow
function in adolescents with unstable OCD, with high return to sports rates and little donor-site morbidity.
Level of Evidence:
Level IV—case series.