Capitellar Osteochondritis Dissecans Lesions of the Elbow: A Systematic Review of Osteochondral Graft Reconstruction Options.

Abstract

PURPOSE:

To systematically evaluate the outcomes and complications of osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) for the surgical treatment of capitellar osteochondritis dissecans (OCD).

METHODS:

A literature search was conducted across 3 databases (PubMed, Cochrane, and CINAHL [Cumulative Index to Nursing and Allied Health Literature]) from database inception through December 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Individual study quality was assessed using the Methodological Index for Non-randomized Studies scale. Studies were published between 2005 and 2019.

RESULTS:

Eighteen studies consisting of 446 elbow OCD lesions treated with OAT surgery were included. There was a single OCA study eligible for inclusion. Patient ages ranged from 10 to 45 years. Of the OAT studies, 4 used autologous costal grafts whereas the remainder used autografts from the knee. Outcome measures were heterogeneously reported. A significant improvement in Timmerman-Andrews scores from preoperatively to postoperatively was reported in 9 of 10 studies. Return-to-play rates to the preinjury level of competitive play ranged from 62% to 100% across 16 studies. Significant improvement in motion, most often extension, was noted in most studies. Reported complication, reoperation, and failure rates ranged from 0% to 11%, 0% to 26%, and 0% to 20%, respectively. When used, knee autografts resulted in low donor-site morbidity (Lysholm scores, 70-100).

CONCLUSIONS:

OAT surgery for large, unstable OCD lesions of the capitellum reliably produced good outcomes, few complications, and a high rate of return to competitive play. Complications are relatively uncommon, and donor-site morbidity is low. Less is known about the performance of OCA given the paucity of available literature.

LEVEL OF EVIDENCE:

Level IV, systematic review of Level II to IV studies.

• Authors: Anthony L Logli, Devin P Leland, Christopher D Bernard, Joaquin Sanchez-Sotelo, Mark E Morrey, Shawn W O'Driscoll, Aaron J Krych, Zhen Wang, Christopher L Camp
• Journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (Arthroscopy) Vol. 36 Issue 6 Pg. 1747-1764 (06 2020) ISSN: 1526-3231 [Electronic] United States
• PMID: 32035172 (Publication Type: Journal Article, Systematic Review)
• Copyright: Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Topics

• Autografts
• Bone Transplantation (methods)
• Elbow Joint (diagnostic imaging, surgery)
• Humans
• Magnetic Resonance Imaging
• Orthopedic Procedures (methods)
• Osteochondritis Dissecans (diagnosis, surgery)
• Plastic Surgery Procedures (methods)