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Arthroscopic All-Inside Suture Fixation and Bone Grafting of Osteochondritis Dissecans Lesions of the Capitellum
Amanda Walsh, MD, Kristen Meier, MD,; Steven Koehler, MD; Jason Pruzansky, MD; Michael Hausman, MD
The Mount Sinai Hosptial, New York, NY

Hypothesis: We hypothesize that a novel technique for all-arthroscopic fixation of capitellum osteochondritis dissecans (OCD) lesions using suture fixation and autogenous iliac crest bone grafting offers a successful alternative to open, internal fixation techniques as measured by validated, patient reported outcomes scores.
Methods: Our technique utilizes arthroscopic all-inside suture fixation with iliac crest autogenous bone grafting. The procedure was performed on four adolescents presenting with five unstable capitellum OCD lesions. The patients were all elite-level athletes: two gymnasts, one baseball pitcher, and one lacrosse player. All patients presented with elbow pain, limited range-of-motion (ROM), and decreased ability to play. MRI provided the diagnosis of an unstable OCD lesion, which was correlated with arthroscopy at the time of surgery. Postoperatively, all patients were immobilized in a long arm cast for 2 months. ROM exercises were then initiated with return to activity as tolerated over a period of 8 weeks. Patients were evaluated prospectively with DASH, Oxford Elbow and Mayo Elbow scores, VAS scores, postoperative ROM and return to play.
Results: Three females and one male aged 13 to 15 years old underwent the procedure. Three patients demonstrated a loss of preoperative terminal extension (average 28 degrees). Two patients underwent failed prior procedures at outside institutions (one retrograde drilling and one internal fixation). Average final follow-up was 2.8 years. All patients went on to union as seen on MRI at an average of 3 months. At follow-up, the average loss of extension was 2 degrees. The average flexion was 153 degrees. There was no loss of supination or pronation. The average DASH score was 11. The average Mayo Elbow score was 88. The average Oxford Elbow score was 42. The average VAS was 2. Average return-to-play was 4 months. All patients continued to compete at an elite level. There were no infections, failure of fixation, need for conversion to open surgery, or revision surgeries.
Summary points:

  • Arthroscopic all-inside fixation of unstable OCD lesions is a successful technique, facilitating athletes to return to elite level of play
  • Our technique results in outcomes comparable to those reported in the literature for open fixation and arthroscopic-assisted fixation (1-3).
  • Drilling from posterior to anterior through the humerus avoids the need for articular surface violation and limits the manipulation of tenuous fragments.
  • Absorbable suture is used, precluding the need for hardware removal should collapse or progression of the lesion occur.

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