Abstract
Background: Since 2005 we have performed cylindrical costal osteochondral autograft for reconstruction of large defects of the elbow due to osteochondritis dissecans.
Methods: Thirty-seven male patients were followed for 18 months with elbow pain due to advanced osteochondritis dissecans whose elbows showed full-thickness articular lesions ≥ 15 mm in diameter. Clinical, radiographic and magnetic resonance imaging (MRI) outcomes were evaluated at a mean follow-up of 38 months (range, 18-60 months).
Results: All cases showed rapid functional improvement after costal osteochondral autograft and they returned to their former activities, including sports. Seven minor surgeries were added, including screw removal, free body removal and shaving of protruded cartilage. Mean elbow function as assessed using the clinical rating system of Timmerman and Andrews was 114 preoperatively, improving to 176 at follow-up, and to 187 after the seven additional operations. Bony union of the graft radiologically was obtained within 3 months in all cases. Revascularization of the graft depicted on T1-weighted MRI imaging and congruity of the reconstructed articular surface depicted on T2-weighted MRI or short tau inversion recovery (STIR) imaging were assessed at approximately 12 and 24 months postoperatively. Functional recovery was good and all patients were satisfied with the final outcomes.
Conclusion: Cylindrical costal osteochondral autografting was useful for treatment of severely damaged elbows such as an articular defects caused by osteochondritis dissecans. Functional recovery was rapid postoperatively. Additional operations were performed for 7 of the 37 cases, while the remaining cases showed almost full recovery. All patients were satisfied with the results, although long-term follow-up is required.
