Muscle-pedicle Bone Grafting With Periosteum Coverage for Osteochondritis Dissecans

Abstract

Objective/Hypothesis: There are several treatment options for osteochondritis dissecans (OCD) of humeral capitellum. In a previous study, we reported muscle-pedicle bone grafting with periosteum coverage for OCD. The purpose of the current study was to review the results of this surgery. Materials and Methods: Eight patients who underwent muscle-pedicle bone grafting with periosteum coverage for OCD between 2011 and 2015 were reviewed retrospectively. The surgical technique is as follows: Unstable OCD lesion was debrided. Cuboid bone graft with the anconeus muscle pedicle was harvested from the posterior side of the capitellum. When obtaining the bone graft, extra periosteum was also obtained and kept attached to the bone graft. Bone tunnel was created from the harvested site to the debrided site. The bone graft was covered with the attached periosteum and inserted through the tunnel. The periosteum edge of the inserted graft was sutured with cartilage around the debrided site. The patients were placed in a long-arm splint for 2 to 3 weeks, followed by gentle mobilization. Gradual return-to-play program was started after radiographic signs of healing. Patients were usually allowed to recover to full sports activity around 6 months after surgery. The medical records of the 8 patients were reviewed for the following information: (1) sports and position; (2) preoperative and final range of motion; (3) duration from surgery to return to sports activity; (4) radiographic outcomes, including size of OCD lesion, grafted bone union, and enlargement of the radial head; and (5) complications. Enlargement of the radial head was defined as an increase in the diameter of more than 20% between preoperative and final anteroposterior radiographs. Results: Eight elbows in 8 patients (7 male and 1 female) with a mean age of 14 years (range, 12-16 years) underwent muscle-pedicle bone grafting with periosteum coverage during the period. Mean follow-up duration was 19 months (range, 6-34 months). Sports, the patients performed, include baseball (7 patients) and tennis (1 patient). In the 7 baseball players, 2 patients were pitchers, 1 was a catcher, 3 were infielders, and 1 was an outfielder. Preoperative range of flexion and extension were 129.4 ± 6.8° (mean ± SD) and −4.4 ± 8.6°, respectively. Final range of flexion and extension were 131.9 ± 11.9° and −2.5 ± 12.8°, respectively. There were no significant difference in preoperative and final range of motion. Patients returned to sports activity in 5 to 7 months after surgery. Seven of 8 patients returned to the same sports level, but 1 patient returned to other sports. The mean anteroposterior and transverse diameters of the cartilage defect were 12.0 (range, 8-14 mm) and 10.6 mm (range, 7-13 mm), respectively. Grafted bone union was achieved in all patients. Enlargement of the radial head was observed in 2 patients. Conclusions: Muscle-pedicle bone grafting with periosteum coverage was one of the acceptable treatment options for OCD of humeral capitellum. Reconstruction of articular defect in OCD was possible with minimum donor site morbidity.