Autologous osteochondral grafting: Promising results in repairing severe capitellar osteochondritis dissecans

As more young athletes participate in competitive sports, orthopedic and sports medicine specialists see a growing number of overuse injuries, including osteochondritis dissecans (OCD). The condition, which most often affects the knee but also occurs in the elbow, may include subchondral bone necrosis, articular cartilage failure, and loose body formation. If left untreated, OCD cause progressive joint damage and impairment.

Capitellar OCD is a relatively common injury among athletes who play sports with a large amount overhead throwing or weight-bearing activities. Both male and female athletes, particularly baseball pitchers and gymnasts, present in Boston Children’s Hospital Orthopedic and Sports Medicine Center with OCD lesions of the developing capitellum.

Treatment options for capitellar OCD

The goal of any OCD treatment is to facilitate bone healing, preserve function and stability of the elbow, and enable athletes to return to their sport. To this end, orthopedic specialists have a host of nonsurgical and surgical options when treating capitellar OCD.

As we report in a previous study, more than half of stable OCD lesions heal with simple time off from sports and observation. However, patients with extensive damage or persistent pain despite a period of rest may need surgery.

A procedure called autologous osteochondral grafting (AOG) replaces diseased bone and cartilage with healthy tissue taken from a donor site, such as the non-weight bearing portion of the lateral femoral condyle. AOG is well established as a treatment for OCD of the knee. For the past 10 years, surgeons in our Orthopedic and Sports Medicine Center have tested the method to repair OCD lesions of the elbow as well.

We describe our preferred surgical technique and share our results in an article for JPOSNA (May 2020).

Early results at Boston Children’s and other research centers show that AOG is as effective or superior to other surgical methods to repair unstable capitellar OCD injury with considerable bone involvement. In numerous studies, 94 percent of patients who underwent AOG returned to their primary sport. By comparison, only 64 percent of patients treated with fixation and 71 percent who underwent microfracture and debridement returned to theirs.

The future of autologous transplantation for capitellar OCD

Boston Children’s continues to study the potential benefits and long-term outcomes of autologous transplantation for capitellar OCD. Despite positive early results, we recognize the need for further study to understand the longer-term impact on patients’ function and mobility. To this end, Boston Children’s is leading a multi-center prospective registry to answer these and other questions about the procedure.

Articles referenced

ET Zheng, A Choi, DS Bae. Autologous Osteochondral Grafting for Capitellar Osteochondritis Dissecans. JPOSNA, May 2020; 2(1).

EL Niu, Frances A Tepolt, DS Bae, DG Lebrun, MS Kocher. Nonoperative management of stable pediatric osteochondritis dissecans of the capitellum: predictors of treatment success. J Shoulder Elbow Surg. 2018 Nov;27(11):2030-2037.

Bae DS, Ingall EM, Miller PE, Eisenberg K. Early Results of Single-plug Autologous Osteochondral Grafting for Osteochondritis Dissecans of the Capitellum in Adolescents. J Pediatr Orthop. 2020 Feb; 40(2):78-85.

Lewine EB, Miller PE, Micheli LJ, Waters PM, Bae DS. Early Results of Drilling and/or Microfracture for Grade IV Osteochondritis Dissecans of the Capitellum. J Pediatr Orthop. 2016 Dec; 36(8):803-809.