Topographic Analysis of the Capitellum and Distal Femoral Condyle: Finding the Best Match for Treating Osteochondral Defects of the Humeral Capitellum
[fusion_builder_container hundred_percent=”no” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” overlay_color=”” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” padding_top=”” padding_bottom=”” padding_left=”” padding_right=””][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” border_position=”all” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” center_content=”no” last=”no” min_height=”” hover_type=”none” link=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” class=”” id=””]Osteochondritis dissecans (OCD) of the humeral capitellum is a localized lesion resulting in separation and fragmentation of the cartilage and underlying bone. Although OCD is largely considered to be an idiopathic condition, its relatively high incidence in adolescent baseball players and gymnasts supports evidence that repetitive microtrauma to the radio-capitellar joint, as well as overuse injury to the anterolateral capitellum, which has a vulnerable epiphysis with a tenuous blood supply, may be responsible for this condition as well. Patients often present with lateral elbow pain, loss of motion, mechanical symptoms, and effusion. Early in the disease process, lesions can be difficult to appreciate on plain radiographs. It is often not until late in the disease process that sclerosis, articular surface irregularity, or loose bodies can be seen on radiographs.
Magnetic resonance imaging is a sensitive tool to diagnose capitellar OCD, and it can also be very useful in aiding in the establishment of a treatment plan. Capitellar OCD lesions that do not show signs of instability can often be initially treated conservatively, especially in patients with open growth plates. If there are radiographic signs of fragment instability, conservative measurements fail, or there are signs of more advanced disease, surgery may be indicated.
Several authors have reported significantly improved short-and long-term results with osteochondral autograft transplantation surgery (OATS) as opposed to isolated debridement of the lesion. OATS has been proposed to treat lesions that involve 50% of the articular surface or more. The donor plugs are pressfitted into the lesion to restore the surface topography and to provide subchondral replacement in the defect. One difficult aspect of this procedure is ascertaining where the optimal graft harvest site is located. Most frequently, grafts are harvested from the periphery of the femoral condyle, at the level of the patellofemoral joint, away from the weight-bearing surfaces, and more specifically, the superolateral aspect of the lateral femoral condyle, as well as the intercondylar notch, has been described. However, no studies to our knowledge have evaluated the topographic osteochondral similarities of the capitellum and the distal femur.
The purpose of this study was to determine the donor zone of most congruent topographic match by comparing 4 donor sites from the femur with 4 potential recipient sites of OCD at the capitellum. Our hypothesis was that each distal femoral donor site would provide a good match to the capitellar surface.
Full Article: Topographic Analysis of the Capitellum and Distal Femoral Condyle: Finding the Best Match for Treating Osteochondral Defects of the Humeral Capitellum[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]