2017 Volume 2 Article ID: 20170002
Objective: Treatment of large advanced osteochondritis dissecans (OCD) of the elbow in young athletes is challenging. Methods: We retrospectively reviewed the results in 9 baseball players (mean age, 13.7 years; range, 12–15 years) who were followed up for a mean 21.1 months (range, 12–36 months) after osteochondral autograft. In this operation, cylindrical osteochondral plugs were harvested from a lateral femoral condyle and transferred to the lesion in humeral capitellum. After immobilizing the elbow by a splint for 2 weeks, the patients were encouraged to do range of motion exercises using an elbow brace with a hinge for 2 months. The elbow brace was applied to avoid excess stress to the implants on the capitellum and to the lateral collateral ligament. Patients were clinically assessed by the Japanese Orthopaedic Association elbow score (JOA score) and morphologically by radiographs as well as by magnetic resonance imaging (MRI). Results: Patients started playing catch at 3 months and returned to baseball at competitive level at around 6 months postoperatively. The average JOA score was 68.0 points before operation and improved to 98.7 points at follow-up. Bony fusion between the implants and host bone was observed radiographically at 3 months. MRI confirmed a durable load-bearing articular surface of the capitellum at 1 year. Conclusions: Osteochondral autograft with postoperative rehabilitation using an elbow brace is a reasonable treatment for young athletes with an advanced lesion of OCD of the elbow who desire a relatively quick return to their pre-injury sports activity level.
