Gallusser Nicolas, Goetti Patrick, Lallemand Geoffroi, Terrier Alexandre, Vauclair Frédéric
Department of Orthopaedic and Trauma Surgery, Valais Hospital, Sion, Switzerland.
Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
J Shoulder Elbow Surg. 2024 Apr;33(4):798-803. doi: 10.1016/j.jse.2023.09.022. Epub 2023 Oct 27.
Osteochondritis dissecans (OCD) of the humeral capitellum is an important cause of elbow disability in young athletes. Large and unstable lesions sometimes require joint reconstruction with osteochondral autograft. Several approaches have been described to expose the capitellum for the purpose of treating OCD. The posterior anconeus-splitting approach and the lateral approach with or without release of the lateral ligamentous complex are the most frequently used for this indication. The surface accessible by these approaches has not been widely studied. This study compared the extent of the articular surface of the capitellum that could be exposed with the Kocher approach (without ligament release) vs. the posterior anconeus-splitting approach. A secondary outcome was the measurement of any additional area that could be reached with lateral ulnar collateral ligament release (Wrightington approach).
The 3 approaches were performed on 8 adult cadaveric elbows: first, the Kocher approach; then, the anconeus-splitting approach; and finally, the Wrightington approach. The visible articular surface was marked out after completion of each approach.
The mean articular surface of the capitellum was 708 mm (range, 573-830 mm). The mean visible articular surface was 49% (range, 43%-60%) of the total surface with the Kocher approach, 74% (range, 61%-90%) with the posterior anconeus-splitting approach, and 93% (range, 91%-97%) with the Wrightington approach. Although the Kocher approach provided access to the anterior part of the capitellum, the anconeus-splitting approach showed adequate exposure to the posterior three-quarters of the articular surface and overlapped the most posterior part of the Kocher approach. A combination of the 2 lateral ulnar collateral ligament-preserving approaches allowed access to 100% of the joint surface.
Most OCD lesions are located in the posterior area of the capitellum and can therefore be reached with the anconeus-splitting approach. When OCD lesions are located anteriorly, the Kocher approach without ligament release is efficient. A combination of these 2 approaches enabled the entirety of the joint surface to be viewed.
肱骨小头剥脱性骨软骨炎（OCD）是年轻运动员肘部残疾的重要原因。较大且不稳定的病变有时需要采用自体骨软骨移植进行关节重建。为治疗OCD，已描述了几种暴露小头的方法。后肘肌劈开入路和外侧入路（伴或不伴外侧韧带复合体松解）是最常用于此适应证的方法。这些入路可暴露的表面尚未得到广泛研究。本研究比较了Kocher入路（不松解韧带）与后肘肌劈开入路可暴露的肱骨小头关节面范围。次要结果是测量尺侧副韧带松解（Wrightington入路）可额外到达的任何区域。
对8具成人尸体肘部进行这3种入路操作：首先是Kocher入路；然后是肘肌劈开入路；最后是Wrightington入路。每种入路完成后标记出可见的关节面。
肱骨小头的平均关节面为708平方毫米（范围573 - 830平方毫米）。Kocher入路时，平均可见关节面占总表面的49%（范围43% - 60%），后肘肌劈开入路为74%（范围61% - 90%），Wrightington入路为93%（范围91% - 97%）。尽管Kocher入路可进入小头的前部，但肘肌劈开入路能充分暴露关节面的后四分之三，且与Kocher入路的最后部重叠。两种保留尺侧副韧带的入路联合可进入100%的关节面。
大多数OCD病变位于小头的后部，因此可通过肘肌劈开入路到达。当OCD病变位于前部时，不松解韧带的Kocher入路有效。这两种入路联合可观察到整个关节面。
