Feroe Aliya G, Langhans Mark T, Sanchez-Sotelo Joaquin, Morrey Mark E, Camp Christopher L
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Video J Sports Med. 2023 Jul 11;3(4):26350254231173701. doi: 10.1177/26350254231173701. eCollection 2023 Jul-Aug.
Osteochondritis dissecans (OCD) of the capitellum can be a disabling condition that typically affects adolescent, overhead athletes. To date, a variety of different surgical treatment options have been described.
Surgical indications for osteochondral allograft transplantation (OCA) for capitellar OCD lesions include failure of nonsurgical management or prior surgery and unstable, full-thickness lesions of almost any size affecting both bone and cartilage. The anconeus preserving approach specifically provides wide access to nearly the entire capitellum and can be used for lesions in almost any location.
The anconeus preserving approach for OCA utilizes the interval between the anconeus and the ulna. With the patient positioned supine and the elbow flexed on an arm table, an incision is made approximately 1 cm lateral to the olecranon and is carried down to the fascia. Electric cautery is used to dissect the interval between the ulna and the anconeus. The anconeus is elevated off the ulna and retracted laterally to expose the underlying joint capsule. An L-shaped capsulotomy is performed over the center of the capitellum, just proximal to the annular ligament of the radial head. A pin is placed into the center of the lesion, perpendicular to the capitellum. A cannulated reamer 0.5 mm smaller than the lesion is used to ream the lesion to a depth of approximately 5 mm. Depth measurements are taken at all 4 poles of the defect. About 3 cc of bone marrow aspirate harvest is then obtained from the ulna using a cannulated needle. The oscillating saw is used to cut the graft to size using the prior measurements. The bone marrow aspirate is placed onto the osseous side of the graft before the osteochondral graft is impacted into the recipient site. The capsulotomy is then closed, and the anconeus is repaired back to the ulna. Postoperatively, patients begin range of motion as soon as tolerated, initiate strengthening at 6 weeks, and initiate return-to-sport programming at 3 months.
Lesions treated with OCA typically demonstrate improvement in all outcome measures, including functional scores, graft incorporation, articular surface congruity, and return-to-sport. Complications and graft failure is rare.
DISCUSSION/CONCLUSION: OCA using an anconeus preserving approach is a reliable option for surgical management of unstable OCD lesions.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
肱骨小头剥脱性骨软骨炎（OCD）可能是一种致残性疾病，通常影响青少年及从事过头运动的运动员。迄今为止，已描述了多种不同的手术治疗选择。
用于肱骨小头OCD病变的骨软骨异体移植（OCA）的手术适应症包括非手术治疗失败或既往手术失败，以及几乎任何大小的不稳定、全层病变，累及骨和软骨。保留肘肌入路特别能广泛显露几乎整个肱骨小头，可用于几乎任何位置的病变。
OCA的保留肘肌入路利用肘肌与尺骨之间的间隙。患者仰卧位，肘部在臂托上屈曲，在鹰嘴外侧约1 cm处做切口，切开至筋膜。用电刀分离尺骨与肘肌之间的间隙。将肘肌从尺骨上掀起并向外侧牵开，以显露下方的关节囊。在肱骨小头中心、桡骨头环状韧带近端上方做L形关节囊切开。在病变中心垂直于肱骨小头置入一枚克氏针。使用比病变小0.5 mm的空心铰刀将病变扩孔至约5 mm深。在缺损的所有4个极测量深度。然后使用空心针从尺骨获取约3 cc骨髓抽吸物。使用先前测量的数据，用摆动锯将移植物切割至合适大小。在将骨软骨移植物打入受区之前，将骨髓抽吸物置于移植物的骨面。然后关闭关节囊切开处，将肘肌修复至尺骨。术后，患者在耐受后尽快开始活动范围练习，6周开始加强锻炼，3个月开始恢复运动计划。
用OCA治疗的病变通常在所有结果指标上均有改善，包括功能评分、移植物融合、关节面一致性和恢复运动情况。并发症和移植物失败很少见。
讨论/结论：采用保留肘肌入路的OCA是治疗不稳定OCD病变的可靠手术选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本稿件提交了患者的豁免声明或其他书面批准形式以供发表。
