Postoperative return to sports was possible for all patients regardless of which treatment they had.
Investigators from the Kerlan-Jobe Orthopaedic Clinic in Los Angeles
found athletes with elbow osteochondritis dissecans lesions treated with two
different arthroscopic techniques returned to their previous levels of sports
The physicians retrospectively analyzed results of arthroscopic
treatment for the osteochondritis dissecans (OCD) lesions with either
microfracture or the osteochondral autograft transfer system (OATS).
Excellent clinical results and excellent return to previous level
of competition was seen with microfracture of osteochondritis dissecans of the
capitellum at early follow-up. At long-term follow-up, good clinical results
and excellent return to previous level of competition were observed with OATS
for lateral OCD lesions of the capitellum, Jonathan D. Chappell, MD,
Surgical log reviewed
Chappell presented results of the study at the American Orthopaedic
Society for Sports Medicine 2008 Annual Meeting. Neal S. ElAttrache, MD, a
co-investigator with Chappell, performed the surgeries over a 10-year period.
Jonathan D. Chappell
Baseball was the predominant sport played by study participants.
For the surgical-log review Chappell and ElAttrache analyzed how the
patients fared clinically and with regard to return-to-sport after arthroscopic
treatment of OCD lesions of the capitellum.
All patients were placed in a supine position. In each case ElAttrache
identified the OCD lesion and performed a local debridement. Based on the
lesion location, the patient underwent microfracture if the lesion was located
centrally on the capitellum or the OATS procedure if it was more laterally
situated and engaged the radial head.
The microfracture group consisted of 11 patients whose average lesion
size was 130 mm2. The average age for the entire group was 16.5
years; 10 patients were right-hand dominant and right elbows were involved in
This athletes OCD lesion was treated with
microfracture due to its central location on the capitellum.
produced by the microfracture of the capitellum can be seen in this
lateral location of this patients OCD lesion made it amenable to
treatment with the osteochondral autograft transfer system (OATS) technique.
five patients who needed OATS treatment had their bone plugs harvested from
their ipsilateral knees.
Images: Chappell JD
At an average follow-up of 36 months, all patients who underwent
microfracture treatment had 100% excellent results based on their clinical
scores, Chappell said. All 11 [patients] returned to their previous level
of competition, he said.
Flexion contracture decrease
Five patients underwent treatment with the OATS procedure for which
ElAttrache used grafts harvested from the ipsilateral knee area.
The OATS groups overall clinical score was nearly as good as the
microfracture groups scores. Three of five had excellent
results, Chappell said. One patient each had good and fair results, but
they all returned to their previous level of competition.
Follow-up averaged approximately 5 years for the OATS group.
The investigators found that postoperative range of motion increased in
the microfracture group. We found a statistically significant decrease in
flexion contracture after surgery, Chappell said. Although these measures
changed between pre- and postoperative time points in the OATS group, the
changes were not as great in the microfracture group.
No serious complications occurred with either procedure, Chappell noted.
This is early clinical follow-up of the microfracture treatment and
long-term results are needed, he said. Additionally the OATS is a
technical operation for select patents when the lateral column is
For more information:
- Jonathan D. Chappell, MD, can be reached at Wake Orthopaedics, 3009
New Bern Ave., Raleigh, NC 27610; 919-452-4258; e-mail:
He has no direct financial interest in any products or companies mentioned in
- Chappell JD, ElAttrache NS. Clinical outcome of arthroscopic
treatment of OCD lesions of the capitellum. Presented at the American
Orthopaedic Society for Sports Medicine 2008 Annual Meeting. July 10-13, 2008.