We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans.
Step 1: Prepare and Position the Patient
Mark the ipsilateral (fifth or sixth) rib.
Step 2: Excise/Debride the Lesion and Create a Cylindrical Hole
Debride necrotic fibrous tissue completely.
Step 3: Elevate the Costal Osteochondral Junction
Elevate the graft carefully from the periosteum and perichondrium to avoid damage to the pleura.
Step 4: Prepare the Osteochondral Autograft
Shape the harvested osteochondral junction like a cone about 18 mm in height, including a 5-mm-high cartilage cap.
Step 5: Place the Graft into the Defect and Close
After packing the grafts, shape and contour the cartilage surface to fit the radial head using a scalpel.
Step 6: Postoperative Treatment
Most patients are able to perform normal daily activities in a few days or a week, but they are not allowed to play sports for three months.
Between 2006 and 2010, we performed this operation in forty-three patients with severe osteochondritis dissecans of the humeral capitellum, and twenty-six cases were followed for more than twenty-four months12.
What to Watch For
Pitfalls & Challenges