Current Concepts: Osteochondritis Dissecans of the Capitellum and the Role of Osteochondral Autograft Transplantation

Abstract

Background: Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology, risks factors, diagnosis, and efficacy of the available treatment options has expanded over recent years, however remains suboptimal. Recent data on patient-reported outcomes following osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the capitellum have been promising but limited. This review seeks to critically analyze and summarize the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. Methods: A comprehensive literature search was conducted. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Combinations of keywords and controlled vocabulary terms were utilized in order to cast a broad net. Relevant clinical, biomechanical, anatomic and imaging studies were reviewed along with recent review articles, and case series. Results: Forty-three articles from our initial literature search were found to be relevant for this review. The majority of these articles were either review articles, clinical studies, anatomic or imaging studies or biomechanical studies. Conclusions: Current evidence suggests that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum.

Keywords: capitellum; elbow; osteochondral autograft; osteochondral lesions; osteochondritis dissecans.

Figure 1.

Anteroposterior plain films from a 13-year-old right-hand-dominant female gymnast/volleyball player who complained of 2 to 3 years of right elbow pain and mechanical symptoms during activity: (A) her preoperative films demonstrate a large Minami stage 2 capitellar defect; (B) her 3-month postoperative films demonstrate osseous integration of the graft and restoration of the articular surface.

Figure 2.

Coronal (A) and sagittal (B) T2-weighted magnetic resonance images demonstrating an unstable osteochondritis dissecans lesion in the anterolateral capitellum as evident by the hyperintense signal surrounding the lesion.

Figure 3.

Intraoperative images from a 16-year-old right-hand-dominant male undergoing osteochondral autograft transplantation for an unstable capitellar osteochondritis dissecans lesion: (A) the lesion is unstable as it is easily elevated from the capitellar surface; (B) the resulting capitellar defect following debridement of the fragment; (C) the capitellar graft site following reaming for graft preparation; (D) restoration of the articular surface after a 10-mm osteochondral plug is placed.

Figure 4.

(A) Sagittal T2-weighted and (B) coronal T1-weighted magnetic resonance images demonstrating osseous integration of an osteochondral autograft with restoration of a congruent articular surface 3 months after undergoing osteochondral autograft transplantation.