Fresh osteochondral allografts may yield excellent outcomes for osteochondritis dissecans
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Key takeaways:
- Fresh osteochondral allograft transplantation yielded excellent outcomes for osteochondritis dissecans of the capitellum.
- All overhead athletes returned to play at the same or higher level.
SAN ANTONIO — Presented results showed patients who underwent fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum had excellent outcomes with a high rate of return to play at midterm follow-up.
“The knee is the most common source of [osteochondral autografts] but there's been reports of between 8% to 11% donor site morbidity, and they're also limited on the size or the diameter of the graft you can get from the knee,” Raffy Mirzayan, MD, orthopedic surgeon at Kaiser Permanente, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting. “That's why, in 2006, I started using fresh osteochondral grafts to essentially avoid any donor site morbidity.”
Mirzayan and colleagues analyzed 35 patients (mean age, 16 years) who failed nonoperative treatment and underwent fresh osteochondral allograft transplantation for osteochondritis dissecans of the humeral capitellum from a single surgeon between 2006 and 2022.
According to the abstract, the cohort included 24 baseball players, five gymnasts, three cheerleaders/tumblers, one tennis player, one student and one patient with avascular necrosis from chemotherapy.
Mean follow-up was 92.6 months. Outcomes included Oxford shoulder scores, single assessment numeric evaluation (SANE) scores, VAS pain scores and return to play.
At follow-up, Oxford scores improved from 25.5 to 46.7 and VAS pain scores improved from 7.5 to 0.3. In addition, mean postoperative SANE score was 90.6. Two patients required loose body removal. However, no other complications were reported.
Among 16 patients (46%) who had postoperative MRIs at a mean 32.6 months, Mirzayan and colleagues found the graft was incorporated in all patients.
“One hundred percent of the overhead athletes were able to return to their sport and perform at the same level or higher for at least 2 years. In that cohort, two of our patients went on to pitch professionally with self-recorded top pitching velocity of 96 and 94 [miles per hour],” Mirzayan said.
“In conclusion, a fresh osteochondral autograft transplantation for the treatment of osteochondritis dissecans of the capitellum provides significant clinical improvement and reduction in pain scores,” he added.
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Mirzayan R, et al. Paper 7. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 16-19, 2024; San Antonio.
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