Abstract
Objectives:
Osteochondral grafting is commonly indicated for osteochondritis dissecans (OCD) of the humeral capitellum in upper extremity athletes. Use of the osteochondral allograft (OCA) as a surgical treatment is sparsely reported in the literature, but donor site morbidity is an increasing concern with the traditionally utilized knee-to-elbow autograft technique in some athletes. The purpose of this study was to evaluate return to sports and patient-reported outcomes in adolescent athletes following OCA treatment for capitellar OCD.
Methods:
An IRB-approved retrospective review of prospectively collected data at a single institution identified patients treated with OCA for capitellar OCD between 2012 and 2022. Inclusion criterion of a minimum of 18 months follow-up for return to sports assessment was applied. OCA transplantation with grafts harvested from the posterior apex of a fresh lateral femoral condyle allograft, or with a precut fresh osteochondral allograft dowel were included. Pre- and postoperative sport and level of sport were recorded. Preoperative and final exam, operative data, complications, and reoperation were recorded. Patient-reported outcome measures (PROMs) of Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), Timmerman–Andrews elbow subjective score, and Hospital for Special Surgery Pediatric-Functional Activity Brief Scale (HSS Pedi-FABS) were evaluated. Postoperative PROMs and range of motion were compared to preoperative values through nonparametric analysis of the Wilcoxon Signed-Rank Test. Categorical variables analyzed with the Fisher exact test, which was dependent on statistical parameters, while continuous variables were analyzed with the Mann-Whitney U test.
Results:
Fifteen Elbows in 13 patients treated with OCA for capitellar OCD were evaluated at an average of 2.5 years postoperatively (r = 1.5-6.3 y). The average age at treatment was 12.7 (r = 10-15) years old and 8 (62%) patients were female. The most common sports were gymnastics (54%) followed by baseball (23%). 12 (92%) of patients competed at the select/club or national/elite level. 47% (7 of 15) elbows had preoperative extension loss averaging 8° (r =4°-20°), with an average pre-operative arc of motion of 133° (r = 105°-145°). Five (33%) elbows presented with a loose body, and 4 (27%) had a concurrent radial head chondral lesion.
At final follow-up, 11 of 12 (92%) patients who attempted to return to the same sport were able to do so. Ninety-one percent (10 of 11) who returned to the same sport achieved the same or higher level of competition.
The average days from surgery to return to sports was 213 days (r = 134-328 days). Final Timmerman-Andrews subjective subscales reflected mild to no symptoms with an average score of 81.3. Patients reported significant improvement in QuickDASH scores (47.7 vs 11.4, p = 0.003) and had increased pre- to postoperative range of motion (130 vs 155, p = 0.008). HSS Pedi-FABS remained high at both time points with no significant difference (29 vs 22, p = 0.2). One elbow (6.7%) demonstrated symptomatic, incomplete graft incorporation and partial graft failure, requiring reoperation for osteochondroplasty at 10 months postoperative. Three additional patients had reoperation for indications not associated with graft union.
Conclusions:
Fresh osteochondral allograft treatment of capitellar OCD demonstrated a high rate of return to the same sport and competition level in adolescent athletes. Reliable improvements in PROMs and range of motion were achieved. The avoidance of possible knee donor-site morbidity is a significant advantage of the OCA compared to knee-to-elbow osteochondral autografts.