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Donor site evaluation after osteochondral autograft transplantation for capitellar OCD
Author(s):
Kinoshita T. (Japan)
Kinoshita T. (Japan)
Affiliations:
ESSKA Academy. Kinoshita T. 05/09/18; 209813; P18-1008 Topic: Sports Related Injuries
Takuya Kinoshita
Takuya Kinoshita
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Abstract
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Objectives: Capitellar osteochondritis dissecans (OCD) often occurs in juvenile athletes, especially baseball players. Osteochondral autograft transplantation (OAT) has been proposed for progressed OCD lesion with good short term results. However, OAT procedure needs to harvest from asymptomatic joint and so we must thoroughly consider donor-site morbidity. The purpose of this study was to evaluate donor-site morbidity of OAT procedure for advanced capitellar OCD and postoperative magnetic resonance imaging (MRI) findings of harvested knees.

Methods: From 2003 to 2014, the medical records, radiographic records and MRI findings for 103 juvenile patients who had undergone OAT by a single surgeon were retrospectively reviewed. Patients who were observed for more than 2 years and assessed by MRI postoperatively were included. Thus, 49 patients met the inclusion criterion. Of these 49 patients (49 elbows), 48 were male and 1 was female. The mean age at the time of the operation was 13.0 years (11 to 15). The mean follow-up period was 50.4 months after surgery (28 to 100). Assessment about knees included IKDC 2000 subjective score, rate of return to sports, symptoms of the donor knee, radiograph and MRI at about 3 years postoperatively. Donor-site morbidity was defined as the presence of persistent symptoms for more than 1 year after graft harvesting or need for subsequent intervention to treat complications related to the donor site. Regarding image, osteoarthritic changes were assessed by radiograph. The quality of the donor site repair was assessed from MRI findings based on magnetic resonance observation of cartilage repair tissue (MOCART) scoring system. The t test was used for continuous variables (IKDC score and MOCART score).

Results: Two patients were determined as donor-site morbidity. These patients complained feeling knee instability during activities. All patients returned to the competitive level of their sports. The average of IKDC score was 99.1. The radiographic findings showed osteophytes at lateral patella in 1 patient without any donor-site morbidity. The overall MOCART score was 65.9 points (35 to 90). The MRI findings showed 50-100% of the adjacent cartilage defect fill in 37 patients (78%) and hypertrophic changes in 11 patients (22%) at the donor harvest sites. Abnormal signals of the repair tissue were found in 17 patients (35%). The repairs of subchondral bone and lamina were not intact in 31 (65%) and 33 patients (69%) respectively.

Conclusions: OAT procedures for juvenile athletes with advanced capitellar OCD were performed and these were good clinical outcomes. The donor-site morbidity rate was relatively low (4.1%). MRI findings showed good defect fill but the repairs of subchondral bone were poor.

Keywords:
OAT, donor site, OCD
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