Elsevier

The Journal of Hand Surgery

Volume 32, Issue 9, November 2007, Pages 1454-1461
The Journal of Hand Surgery

Surgical technique
Technique of Osteochondral Autograft Transplantation Mosaicplasty for Capitellar Osteochondritis Dissecans

https://doi.org/10.1016/j.jhsa.2007.08.016Get rights and content

Osteochondritis dissecans (OCD) is a localized condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Various theories about its etiology have been proposed, but the exact etiology of OCD still remains obscure. Osteochondritis dissecans of the elbow is characterized by pain, swelling, and limitation of motion, usually in adolescence through early adulthood. An uncommon clinical entity, it occurs as a result of overuse injuries, especially throwing activities. The treatment of OCD has evolved from the removal of loose bodies to the resurfacing of defects with an osteochondral autogenous graft (mosaicplasty). Mosaicplasty is a relatively new and viable option for the treatment of advanced OCD of the capitellum. In this article, we describe the technique of mosaicplasty for OCD of the capitellum.

Section snippets

Preoperative Evaluation and Indications

Throwing athletes and gymnasts are subjected to repetitive forces to the lateral elbow and are at risk for capitellar OCD, especially when engaged in aggressive training at a young age. Pain, limitation of motion, clicking or locking of the joint, and swelling are the usual presenting complaints. Locking of the joint suggests the presence of an intra-articular loose body.

Physical examination often reveals a flexion contracture and tenderness over the lateral joint line. The range of motion is

Surgical Technique

Under general anesthesia, the patient is positioned in the supine position. This position facilitates donor graft harvest from the knee. Using standard aseptic precautions and skin preparation, the affected extremity and the ipsilateral leg are draped. The affected upper limb is draped as proximally as possible, and a sterile pneumatic tourniquet is used. The ipsilateral leg is draped similarly, as proximally as possible, and another sterile pneumatic tourniquet is applied to the thigh. The

Postoperative Protocol

The patient’s elbow is immobilized in 80° to 90° of flexion with the forearm in neutral pronosupination for 3 weeks. At 4 weeks after surgery, active and passive range of motion exercises are encouraged. Strengthening exercises are commenced in the third month after surgery. The patients usually return to active sports at the end of 6 to 8 months. By the end of 1 year after surgery, the patients are able to attain their previous level of activities.

Complications

Complications most frequently are related to the graft donor site. The donor site is left empty after harvest of the small cylindrical grafts. The donor tunnels, after the grafts are harvested, are covered with initial repair tissue in 6 weeks, and a fibrocartilage coverage develops in 8 to 12 weeks.31 Although clinical reports have indicated that the fibrocartilaginous surface can serve as appropriate coverage for the less weight-bearing area, excessive bleeding from the donor tunnels seems to

Discussion

Osteochondral autografts have recently become popular to treat articular cartilage defects, and they are used for unstable osteochondritis dissecans lesions as a means of biological fixation and osteochondral resurfacing of elbow osteochondritis dissecans.22 Several recent encouraging reports in the literature19, 20, 22, 23 have suggested that osteochondral mosaicplasty may be a viable alternative option for treating capitellar OCD in teenaged baseball players. We have had similar encouraging

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  • Cited by (23)

    • Outcomes of Osteochondral Autograft Transplantation in Pediatric Patients With Osteochondritis Dissecans of the Capitellum

      2021, Journal of Hand Surgery
      Citation Excerpt :

      A recent report by Bae et al30 using our previously reported technique on the treatment of advanced capitellar OCD lesions with large-plug osteochondral grafts has shown excellent short-term outcomes, with a 100% return to general sports participation after 6 months.9 Their results are comparable with our results and other published results.1,2,4–7,18,20–29 We used a single plug whenever possible (11 of 15 patients), but patients with larger deficits (>1 cm) required multiple plugs.

    • Osteochondritis Dissecans of skeletal elements of the foot in a 19th century rural farming community from The Netherlands

      2017, International Journal of Paleopathology
      Citation Excerpt :

      However, when continuous loading is imposed, the healing mechanisms of bone, and thus its remodeling, may decrease leading to bone necrosis (Schindler, 2007). OD frequently occurs in athletes (Aichroth, 1971) and particularly throwing athletes and gymnasts (Baker and Romeo, 2010; Schenk and Goodnight, 1996; Wahegaonkar et al., 2007). In the ideal case of early detection and treatment of the lesion, the repair mechanism, especially in juvenile patients may be entirely successful; yet in most cases it is not (Schindler, 2007).

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