Background: Effective treatment of osteochondral lesions in the
elbow remains challenging. Arthroscopic débridement and microfracture
or retrograde drilling techniques are often insufficient and provide only
temporary symptomatic relief. The purpose of this study was to evaluate the
treatment of these lesions with osteochondral autografts.
Methods: From 1999 to 2002, seven patients with osteochondral
lesions of the capitellum humeri (five patients), trochlea (one patient), or
radial head (one patient) were treated with cylindrical osteochondral grafts,
which were harvested from the non-weight-bearing area of the proximal aspect
of the lateral femoral condyle. The patients (three female and four male
patients with an average age of seventeen years) were evaluated preoperatively
and postoperatively, with an average follow-up of fifty-nine months. The
Broberg and Morrey score was chosen for functional evaluation of the elbow
(with regard to motion, pain, strength, activities of daily living, and
stability), and the American Shoulder and Elbow Surgeons score was used for
the analysis of pain. All patients had imaging studies done preoperatively to
evaluate the defect and postoperatively to assess the ingrowth and viability
of the graft. The ipsilateral knee was examined for donor-site morbidity.
Results: The Broberg and Morrey score improved from a mean (and
standard deviation) of 76.3 ± 13.2 preoperatively to 97.6 ± 2.7
postoperatively, and pain scores were significantly reduced (p < 0.05). The
mean elbow extension lag of 4.7° ± 5.8° was reduced to 0°
postoperatively. Compared with the contralateral side, there was a mean
preoperative flexion lag of 12.9° ± 13.8°. At the time of the
final follow-up, flexion was free and was equal bilaterally in all patients.
None of the plain radiographs made at the time of follow-up showed any
degenerative changes or signs of osteoarthritis. The postoperative magnetic
resonance imaging scans showed graft viability and a congruent chondral
surface in all seven patients. No donor-site morbidity was noted at one year
Conclusions: The osteochondral autograft procedure described in the
present study provides the opportunity to retain viable hyaline cartilage for
the repair of osteochondral lesions in the elbow while restoring joint
congruity and function and perhaps reducing the risk of osteoarthritis. These
medium-term results suggest that the risks of a two-joint procedure are modest
and justifiable. In addition, the described technique provides an option for
revision surgery after the failure of other surgical procedures.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.