Osteochondritis Dissecans Open Surgery
Open approach for osteochondritis dissecans (OCD) of the elbow includes debridement of the lesion, fixation with bone pegs or wires, reconstruction with osteochondral autograft, etc. Preoperative assessment of the lesion is important to decide the surgical option; however, the final decision of the procedure is done according to the arthroscopic or direct findings of the lesion. In our protocol, a lesion suspected International Cartilage Research Society (ICRS) OCD-I is basically a candidate of conservative treatment. For a stable lesion with partial articular cartilage discontinuity (ICRS OCD-II), fixation procedure such as bone pegs fixation should be applied. For an unstable lesion (ICRS OCD-III or OCD-IV), arthroscopic debridement is applied at first. After debridement of the lesion, reconstructive procedure is chosen dependent on the lesion size and donor site preference. For a larger lesion, multiple osteochondral plug grafts (so to speak, mosaicplasty; MOSAIC) or cylindrical costal osteochondral autograft (CCOA) is chosen. For a moderate-sized lesion, anconeus muscle-pedicle bone graft with periosteum coverage (ABGP) is an option which can be converted from either supine or prone position. Reconstruction procedure is a little complicated; however, this surgical option should be considered in some selected cases such as very progressive large lesion in young athletes.
KeywordsCapitellum Osteochondritis dissecans Osteochondral autograft Lateral femoral condyle Rib
The authors would like to thank Drs. Takeshi Fuji, Hajime Owaki, and Ryosuke Noguchi for their help collecting data and providing scientific advice.
Declaration of Conflict of Interest: We, Drs. Shimada, Temporin, Oura, and Tanaka, have no conflicts of interest to declare.
Approach and debridement of the unstable fragments for reconstruction (WMV 15201 kb)
Make a cylinder hole for the recipient (WMV 4536 kb)
Costal rib harvesting (WMV 22943 kb)
Preparation of rib graft (WMV 6857 kb)
Osteochondral costal rib graft with a bony wedge (WMV 13302 kb)