Capitellar Osteochondritis Dissecans Lesions of the Elbow: A Systematic Review of Osteochondral Graft Reconstruction Options

PURPOSE:

To systematically evaluate outcomes and complications of osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) for the surgical treatment of capitellar osteochondritis dissecans (OCD).

METHODS:

A literature search was conducted across 3 databases (PubMed, Cochrane, CINAHL) from database inception through December of 2019 in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Individual study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) scale. Studies were published between 2005 and 2019.

RESULTS:

Eighteen studies consisting of 446 elbow OCD lesions treated with OAT surgery were included. There was a single OCA study eligible for inclusion. Patient age ranged from 10-45 years old. 4 of the OAT studies utilized autologous costal grafts while the remainder used autografts from the knee. Outcome measures were heterogeneously reported. A significant improvement in Timmerman & Andrews (T&A) scores from pre- to post-operative was reported in 9/10 studies. Return to play (RTP) rates to the pre-injury level of competitive play ranged from 62-100% across 16 studies. Significant improvement in motion, most often extension, was noted in most of the studies. Reported complication, reoperation, and failure rates ranged from 0-11%, 0-26%, and 0-20%, respectively. When used, knee autografts resulted in low donor site morbidity (Lysholm scores, 70-100).

CONCLUSIONS:

OAT surgery for large, unstable OCD lesions of the capitellum reliably produced good outcomes, few complications and a high rate of return to competitive play. Complications are relatively uncommon and donor site morbidity is low. Less is known about the performance of OCA given the paucity of available literature.