Background:Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern.Purpose:To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period.Study Design:Case series; Level of evidence, 4.Methods:After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments.Results:A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications.Conclusion:FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.

中文翻译：

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新鲜同种异体小头骨软骨移植治疗剥脱性骨软骨炎


背景：肱骨小头剥脱性骨软骨炎（OCD）是一种罕见且具有挑战性的疾病。存在多种手术选择，但在过去几年中，钟摆已经从清创和微骨折转向关节面修复。肋骨和膝盖的自体骨软骨移植已经被描述，但供体部位的发病率是一个问题。目的：扩大先前发表的报告中新鲜骨软骨同种异体移植（FOCAT）的结果，纳入更多患者和更长的随访研究设计：案例系列；证据级别，4。方法：经机构审查委员会批准后，对 2006 年至 2022 年期间由一位外科医生因小头强迫症接受 FOCAT 治疗的患者的图表进行了审查。大多数病例 (94%) 具有不稳定病变 (Minami 2 级和 3 级)。一项非手术治疗试验全部失败。所有患者均接受诊断性关节镜检查，然后使用市售导板和器械进行微型开放、保留韧带的手术，并进行移植。 结果：总共确定了 35 名患者，其中 25 名是男性。平均年龄为 16 ± 3.9 岁（范围：11-32 岁）。其中有 24 名棒球运动员（19 名投手和 5 名位置球员）、5 名体操运动员、3 名拉拉队/翻滚运动员、1 名网球运动员、1 名学生（未参加田径比赛）和 1 名因化疗导致缺血性坏死的患者。 18 名患者的平均屈曲挛缩为 14.1°± 11.9°。 23 名患者使用单个骨软骨同种异体移植栓（平均直径 11.3 ± 2.8 mm），12 名患者需要 2 个骨栓（万事达卡技术）。平均随访时间为 92.6 ± 54.5 个月（范围：24-204 个月）。牛津大学有显着改善（从 25.5 ± 4.9 到 46.7 ± 3.5；P < .00001）和疼痛视觉模拟量表（从 7.5 ± 2 到 0.3 ± 1.0；P < .0001）评分。随访时的平均单一评估数字评估分数为 90.6 ± 10.8（范围，60-100）。在过头运动员中，Kerlan-Jobe 骨科诊所评分有显着改善（从 40.8 ± 11.8 到 90.6 ± 10.8；P < .00001）。 16 名 (46%) 患者在平均 32.6 个月时进行了术后磁共振成像扫描。在所有情况下，移植物均被合并。所有高空运动员都能够恢复其运动并在超过 2 年的时间里保持相同或更高的水平。两个肘部随后需要进行关节镜检查以去除游离体；结论：FOCAT是治疗肱骨小头强迫症病变的良好选择。观察到良好的结果和高恢复运动率，中期随访显示没有移植失败。 FOCAT 消除了供体部位发病率。