Tingey Mitchell T, Glover Mark A, St Jeor Jeffery D, Trasolini Nicholas A, Albertson Benjamin S, Fiegen Anthony P, Waterman Brian R
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2024 Mar 5;4(2):26350254231200586. doi: 10.1177/26350254231200586. eCollection 2024 Mar-Apr.
Osteochondritis dissecans (OCD) affects the shoulder in only 0.6% of patients aged 2 to 19 years with disease most commonly in the humeral head. When the glenoid is affected, it is often in male overhead throwing athletes and treated with fixation via autologous osteochondral plugs following bone marrow aspirate.
The primary indication for surgical management of OCD is failure of conservative management, often with imaging showing disruption of the glenoid subchondral plate. This patient is an 18-year-old male pitcher with over 2 years of chronic, deep-seated shoulder pain unresponsive to conservative management.
We present a primary arthroscopic technique of autologous bone marrow aspirate concentrate graft for management of OCD in an 18-year-old college baseball pitcher. The patient was placed in the left lateral decubitus position with an axillary roll and standard portals were established. A loose fragmented flap with no underlying osseous material was debrided and a 3-cm central area of bony loss was identified. Bone marrow aspirate of 80 mL was taken from the anterior superior iliac crest. The aspirate was mixed with Biocartilage (Arthrex) to fill the defect flush with the surrounding tissue and sealed with fibrin glue. Ports were closed and an abduction sling was applied.
A recent review article demonstrated that athletes who underwent surgical management of OCD lesions returned to sports an average of 1.2 months sooner than those managed non-operatively, though this difference was not significant. This patient had a full return to play at 9 months. At 1-year follow-up, he made a full recovery and is currently playing professionally without shoulder pain.
DISCUSSION/CONCLUSION: Autologous bone marrow aspirate defect filling is a viable treatment of OCD, even in high-level overhead throwing athletes. It allows for arthroscopic treatment with long-term success in the treatment of pain and function.
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.
剥脱性骨软骨炎（OCD）在2至19岁的患者中仅0.6%累及肩部，疾病最常发生于肱骨头。当肩胛盂受累时，多见于男性过头投掷运动员，治疗方法通常是在骨髓抽吸后通过自体骨软骨栓进行固定。
OCD手术治疗的主要适应证是保守治疗失败，影像学检查常显示肩胛盂软骨下板中断。该患者为一名18岁的男性投手，有超过2年的慢性、深部肩部疼痛，对保守治疗无反应。
我们介绍了一种用于治疗一名18岁大学棒球投手OCD的自体骨髓抽吸浓缩物移植的初次关节镜技术。患者置于左侧卧位，腋窝处垫一软枕，建立标准入路。清理一块无下方骨质的松动碎骨瓣，确定一个3厘米的中央骨质缺损区。从髂前上棘抽取80毫升骨髓抽吸物。将抽吸物与生物软骨（Arthrex公司）混合，填充缺损使其与周围组织齐平，并用纤维蛋白胶密封。关闭入路，应用外展吊带。
最近一篇综述文章表明，接受OCD病变手术治疗的运动员比非手术治疗的运动员平均提前1.2个月重返运动项目，尽管这种差异并不显著。该患者在9个月时完全恢复比赛。在1年的随访中，他完全康复，目前正在职业比赛，无肩部疼痛。
讨论/结论：自体骨髓抽吸物填充缺损是OCD的一种可行治疗方法，即使对于高水平过头投掷运动员也是如此。它允许通过关节镜治疗，在疼痛和功能治疗方面取得长期成功。
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，作者在提交本出版物时已包含患者的豁免声明或其他书面批准形式。
