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Cylindrical Costal Osteochondral Autograft for Reconstruction of Large Defects of the Capitellum Due to Osteochondritis DissecansSurgical Technique
Kozo Shimada, MD, PhD1; Hiroyuki Tanaka, MD, PhD1; Taiichi Matsumoto, MD2; Junichi Miyake, MD3; Haruhisa Higuchi, MD, PhD4; Kazushige Gamo, MD4; Takeshi Fuji, MD, PhD1
1 Department of Orthopaedic Surgery, Osaka Koseinenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan. E-mail address for K. Shimada: k-shimada1960@nifty.com
2 Department of Orthopaedic Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
3 Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita Osaka 565-0871, Japan
4 Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata, Osaka 573-8511, Japan
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Based on an original article: J Bone Joint Surg Am. 2012 Jun 6;94(11):992-1002.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Jun 27;2(2):e12 1-11. doi: 10.2106/JBJS.ST.K.00037
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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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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