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American Association for Hand Surgery

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Radius-of-Curvature Analysis of Osteochondral Autologous Transplantation in Pediatric Osteochondritis Dissecans Lesions of the Capitellum
Alexandria J Sherwood, M.D.1, Benjamin Gundlach, M.D.1, Eileen A Crawford, M.D.1, Kagan Ozer, M.D.1, Conor S Daly-Seiler, M.S.1, Adam Abraham, PhD1 and Jeffrey N Lawton, MD2, (1)University of Michigan, Ann Arbor, MI, (2)Orthopaedic Surgery, University of Michigan, Ann Arbor, MI

Title: Radius-of-Curvature Analysis of Osteochondral Autologous Transplantation in Pediatric Osteochondritis Dissecans Lesions of the Capitellum
Hypothesis:
The purpose of this study was to use magnetic resonance imaging (MRI) to assess the capitellum afflicted by osteochondritis dissecans (OCD) lesions in our pediatric subjects. MRI's were obtained pre-operatively and we were then able to compare native radius-of-curvature (ROC) deficits with those same patients following osteochondral autologous transplant (OAT) from the subject's lateral femoral condyle. We hypothesize that post-operative MR images will show clinically acceptable restoration of capitellar joint surface and curvature following this procedure.
Methods:
This was a retrospective study of pediatric patients with OCD lesions that were managed surgically. Patients underwent osteochondral autograft transfer from lateral femoral condyle to involved capitellum. MRI's were obtained pre-operatively, 3 months post-operatively, and 1 year post-operatively. To analyze restoration of capitellar ROC, a modification to the magnetic resonance observation of cartilage tissue (MOCART) classification described by Marlovits and colleagues in combination with best-fit circles was utilized with processing performed in Dragonfly software (Object Research Systems; Montreal, Canada). Sagittal images of the capitellum were analyzed for area of sunken and proud tissue as compared to a best-fit circle simulating the ideal profile of the capitellum.
Results:
Seven patients met inclusion criteria for this study. Pre-operatively, the average area of capitellar sunken cartilage surface in the defect (compared to ideal profile) was 12.61 mm2. At 3 months post-operatively, average capitellar surface was found to be 3.60 mm2 sunken. At 1 year, this average was 3.05 mm2 sunken. No patient was found to have a cartilage surface that was proud/prominent to the projected ideal profile. At one year post-operatively, 3 patients (42%) were found to have complete filling of cartilage defect, the remaining 4 (57%) had under-filling with less than 50% deficit, remaining. Four patients were found to have an increase in the amount of sunken surface between their post-operative imaging at 3 months and 1 year.
Conclusion:
This analysis of cartilage surface restoration following OAT procedures for pediatric OCD lesions of the capitellum shows significant restoration of contour in post-operative MRI's compared to their pre-operative defects. This study provides further support for utilization of OAT for management of pediatric OCD lesions. Beyond that, given that all patients were found to have sunken surfaces in region of autograft, this provides useful information for surgeons in their decision-making when finalizing graft placement.


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