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Surgical Techniques   |    
Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage AthletesSurgical Technique
Norimasa Iwasaki, MD, PhD1; Hiroyuki Kato, MD, PhD2; Jyunichi Ishikawa, MD, PhD1; Tatsuya Masuko, MD, PhD1; Tadanao Funakoshi, MD, PhD1; Akio Minami, MD, PhD1
1 Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan. E-mail address for N. Iwasaki: niwasaki@med.hokudai.ac.jp
2 Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
View Disclosures and Other Information
DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, and the Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 91-A, pp. 2359-66, October 2009
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Sep 01;92(Supplement 1 Part 2):208-216. doi: 10.2106/JBJS.J.00214
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Abstract

BACKGROUND: 

Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans.

METHODS: 

From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery.

RESULTS: 

Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112° ± 17° preoperatively to 128° ± 12° postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 ± 23 points preoperatively to 191 ± 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient.

CONCLUSIONS: 

The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.

LEVEL OF EVIDENCE: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: 

"Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes" (2009;91:2359-66).

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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