Abstract
Background:
Elbow osteochondritis dissecans (OCD) lesions requiring grafting can be treated with osteochondral autograft transfer system (OATS) or osteochondral allograft (OCA). In the adult populations, OATS is associated with 7.8% donor site morbidity; however, donor site morbidity in children and adolescents remains scarcely described.
Hypothesis:
We hypothesized that post-operative knee outcomes in patients undergoing capitellar OCD treatment with OATS would be inferior to those treated with OCA.
Methods:
The electronic medical record database was queried at a single center tertiary care pediatric hospital to identify and analyze patients aged 11 to 18 who underwent operative intervention for elbow capitellar OCD with OATS or OCA from 2008-2024. Standard demographic data (age, sex, race, BMI) and surgical details were collected retrospectively. Validated patient reported outcome measures (PROMs) for the knee (PROMIS, Lysholm score, and IKDC) were prospectively collected at a minimum of 2-year follow-up. Demographic and complication data were included regardless of follow-up length. Standard statistical analysis was used to compare OATS and OCA patients. A subanalysis was performed to compare OATS patients who did and did not undergo donor site backfilling.
Results:
A total of 46 patients were included in the study, 54.3% male, with a mean age of 14.0 (11.1-17.3) years. Thirty-seven (80%) patients underwent OATS and 9 (20%) underwent OCA, of which 22 and 6, respectively, participated in the call-back PRO surveys. Overall demographics between groups were similar. Within the OATS group, the right knee donor site was most common (70.3%), likely reflecting the more commonly affected right elbow. An average of 1.32 plugs were obtained. Five patients (13.5%) underwent subsequent knee surgery, all of whom underwent chondroplasty for fibrocartilage overgrowth, whereas no OCA patients required subsequent knee surgery . All patients who required subsequent surgery underwent backfilling of the donor site (5/22, 22.7%), which trended towards significance when compared with those that did not undergo backfilling. Whereas 83.3% of OCA patients returned to sport, 45.5% of OATS patients were unable to return to sport, 40.0% of whom reported knee pain as the reason.
Conclusion:
In this series, 13.5% of children and adolescents who underwent OATS for capitellar OCD lesions required future knee arthroscopy, and 40% of patients who were unable to return to sport reported symptoms at the knee. Consideration for OCA in managing these injuries should be given to avoid donor site morbidity associated with OATS. Backfilling the donor site may increase the likelihood of future knee surgery.
