121.
Autologous Osteochondral Mosaicplasty for osteochondritis dissecans
of the humeral capitellum in young patients.
Janne Ovesen, Hans Viggo Johannsen
Shoulder and Elbow Unit, Department of Orthopaedic Surgery Aarhus
University Hospital; Shoulder and Elbow Unit, Department of Orthopaedic
Surgery, Aarhus University Hospital
Background:
Autologous osteochondral mosaicplasty is a relatively new
technique to promote hyaline repair for articular cartilage defects.
Purpose / Aim of Study:
To report the clinical outcomes of mosaicplasty in
the treatment of advanced stages of osteochondritis dissecans of the distal
humeral capitellum
Materials and Methods:
Between 2003 and 2010, 13 patients with advanced
lesions of capitellar osteochondritis dissecans underwent mosaicplasty . The
average age was 18 years (13 to 27). The surgical technique involved obtaining
small-sized cylindrical osteochondral grafts from the lateral margen of the
femoral condyle at the level of the patellofemoral joint and transplanting them
to the defect of the capitellum. At a mean follow-up of 27 months, all patients
were evaluated clinically and radiographically. All elbows were assessed using
the Mayo elbow performance score and a modified functional elbow score.
Findings / Results:
Radiograpical evaluations at follow-up included standard
AP and lateral x-rays and MRI or CT. In all cases incorporation of the grafts, a
normal contour of the subchondral cortex covered by a normally appearing
cartilage layer was demonstrated. All patients except two were completely pain
free after surgery. 11 patients (85%) had no reduction in ROM. 2 patients had
loss of extension preoperatively, although ROM was better after surgery, they
still had an extension deficit. Using the Mayo elbow performance score the
non-operated elbows had a mean score of 100 points whereas the operated
elbows had a mean score of 93.5 points. The functional elbow score showed a
mean difference of 7.5 points between the operated and non-operated elbow.
There were no complications and no donor site morbidity at follow-up
Conclusions:
Autologous osteochondral mosaicplasty for advanced stages of
capitellar osteochondritis dissecans can provide good clinical and radiographic
results in young patients.
