2025 ISAKOS Biennial Congress Paper
Return to Sport and Patient-Reported Outcomes of Osteochondral Allograft for Capitellar Osteochondritis Dissecans in Adolescent Athletes
Philip Wilson, MD, Dallas, TX UNITED STATES
Junho Ahn, MD, Dallas, Texas UNITED STATES
Claire Clark, BS, Dallas, Texas UNITED STATES
Charles W Wyatt, CPNP, Plano, Texas UNITED STATES
Benjamin Johnson, PA-C, Frisco, TX UNITED STATES
Garrett Sohn, MD UNITED STATES
Henry B. Ellis, MD, Frisco, TX UNITED STATES
Scottish Rite for Children, Dallas, Texas, UNITED STATES
FDA Status Not Applicable
Summary
The avoidance of possible knee donor-site morbidity is a significant advantage of the OCA compared to knee-to-elbow osteochondral autograft.
Abstract
Introduction
Osteochondral allograft (OCA) for treatment of osteochondritis dissecans (OCD) of the humeral capitellum is sparsely reported in the literature, but donor site morbidity is an increasing concern with the traditionally utilized knee-to-elbow autograft technique. The purpose of this study was to evaluate return to sport and patient reported outcomes in adolescent athletes following osteochondral allograft treatment for capitellar OCD.
Methods
An IRB-approved review of prospectively collected data at a single institution identified patients treated with OCA for capitellar OCD between 2012 and 2021. Inclusion criterion of a minimum of 2 year follow-up was applied. Fresh lateral femoral condyle allograft (posterior apex), or pre-cut fresh osteochondral allograft dowel were utilized. Pre- and post-operative sport and level, exam and operative data, complications, and re-operation were recorded. Patient reported outcome measures (PROM) of Quick Dash (qDASH) and Timmerman–Andrews (T-A) elbow subjective score were evaluated.
Results
21 Elbows in 18 patients (12.7 ± 1.6 years; 61.1% were female) treated with OCA for capitellar OCD were evaluated at an average of 5.1 years post-operatively (r= 2.1-10.6 y). The most common sports were gymnastics (66.7%) followed by baseball (14.3%). 38.1% (8/21) elbows had pre-operative extension loss averaging 10.8° (r=3°-20°), with average motion arc 136.1° (r= 85°-155°). 6 (28.6%) elbows presented with a loose body, and 6 (28.6%) had a radial head osteochondral lesion.
At final follow-up, 17/18 (94.4%) patients who attempted to return to the same sport were able to do so. 77.8% (14/18) who returned to the same sport achieved the same or higher level of competition. Final T-A subjective subscales reflected mild to no symptoms at an average score of 91.9. Patients reported significant improvement in qDASH scores (37.12 vs 8.07, p= 0.001) and had increased pre- to post-operative range of motion (136.05 vs 143.43, p= 0.046). 1 elbow (4.8%) demonstrated symptomatic, incomplete graft incorporation and partial graft failure, requiring reoperation for osteochondroplasty at 10 months post-operative. 1 elbow (4.8%) required reoperation for graft loosening. 4 additional patients had re-operation for indications not associated with graft union.
Conclusion
Fresh osteochondral allograft treatment of capitellar OCD demonstrated a high rate of return to same-sport and competitive level in adolescent athletes. Reliable improvement in PROM and range of motion was achieved. The avoidance of possible knee donor-site morbidity is a significant advantage of the OCA compared to knee-to-elbow osteochondral autograft.