Introduction 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.
Results 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 Indications
Pitfalls & Challenges
We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans.
Osteochondritis dissecans of the humeral capitellum is a common sports-related disorder in young athletes, especially baseball players and gymnasts. With advanced osteochondritis dissecans of the capitellum, radiocapitellar incongruity develops and treatment remains challenging, particularly with a large, full-thickness articular cartilage defect. Studies have shown that a large articular defect reaching to the lateral cortex is a risk factor for subsequent degenerative changes and should be treated with repair or reconstruction1-4.
The ribs are a potential donor site for osteochondral grafts comprising combined hyaline cartilage and structural bone. Several authors have …
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