Name: Allograft OATS® Technique for an Elbow Osteochondral Defect
Uploaded: 2021-12-02T00:00:00Z
Channel: Arthrex
Description: S. Clifton Willimon, MD (Atlanta, GA), presents a case in which he treated a capitellar osteochondral defect using the allograft OATS® technique. Dr. Willimon highlights the benefits of the anconeous approach for allograft OATS procedures, including better visualization of the capitellar defect and perpendicular access to the articular surface to ensure a well-placed graft.

Orthobiologics

Elbow

<p>S. Clifton Willimon, MD (Atlanta, GA), presents a case in which he treated a capitellar osteochondral defect using the allograft OATS® technique. Dr. Willimon highlights the benefits of the anconeous approach for allograft OATS procedures, including better visualization of the capitellar defect and perpendicular access to the articular surface to ensure a well-placed graft.</p>

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VID1-002821-en-US | A | Allograft OATS® Technique for an Elbow Osteochondral Defect

Clifton Willimon

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Allograft OATS® Technique for an Elbow Osteochondral Defect

Hi, I'm Cliff Willaman and I practice at Children's Healthcare of Atlanta in Atlanta, Georgia. I'd like to present a brief presentation in case of an osteochondral allograft transplantation for Capitellum osteochondritis. Dissecans graft transplantation is classically reserved for large lesions of the capitellum greater than a centimeter in diameter, or lesions that comprise more than 50% of the articular surface, or lesions extending into the lateral border of the capitellum, classically termed shoulder lesions. It's also useful in revision settings after failed marrow stimulation in an athlete who wishes to return to the pre-injury level of sport. In contrary, it's contraindicated to settings in degenerative changes of the rate of capitellum joint or untreated elbow instability. Graft sources come from a variety of locations. We can use non-weight bearing portions of the knee in an autograft or allograft scenario. Costal grafts from the sixth rib have been used, as well as more recently, allografts from a variety of sources. Graft survival has been documented at 90% at ten years after autographed. A recent systematic review has shown a much higher return to sport rate in baseball players, as compared to Mary's stimulation for these larger defects showing a 75% return after Mary's stimulation compared to a more superior result at 94% return after autograph transplantation. I like to present a brief case presentation of a teenage female gymnast who presented after four months of left elbow pain, clicking and catching, followed by months after pain from tumbling. She had seen multiple physicians, had undergone a long course of physical therapy and more recently, three months of complete rest. Radiographs were obtained in clinic and AP and lateral views are shown. Here we can see a large, clearly visualized OCD of the capitellum. The rest of the elbow joint is well preserved. An MRI was obtained and representative images are shown here with a sagittal view on the left showing a large, unstable OCD of the capitellum with early delamination of the articular surface. On the coronal view on the right, we can see its true width, which it spans nearly the entire width of the capitellum. The patient subsequently underwent surgery for this unstable lesion, starting first with arthroscopy. The arthroscopic images show that the elbow joint is well preserved. Aside from the OCD, there is a large impinging synovial plica secondary to chronic inflammation from the OCD. There are no loose bodies. Posterior elbow arthroscopy shows more clearly the OCD, its width and breadth. We can see in the bottom right image the delamination of the cartilage over the large area. But again, the rest of the elbow joint was in wonderful condition, making this patient a great candidate for graft transplantation. Following this, we proceeded with allograft transplantation. This was done in the same operative setting in the same position, so lateral decubitus position was utilized. This is the same position I used for arthroscopy, so no change of positioning is necessary. It allows us to hyper flex the elbow to deliver that portion of the capitellum needed for transplantation. I prefer an anconeus splitting approach over the more traditional coker approach to access the capitellum for these procedures, because, as we know from a long experience in knee graft transplantation, perpendicular access to the articular surface is critical for a well placed graft. And so by using an anconeus splitting approach and hyper flexing the elbow, it gives us exactly that exposure. The next slide shows the graft preparation for the recipient site. We can see we're reaming after breeding the unstable cartilage. It was sized as a 12 millimeter diameter plug. And we can see the final preparation of the recipient site followed by insertion of the graft. Again a 12 millimeter diameter fresh allograft osteochondral plug. The capsule is then repaired, followed by the repair of the anconeus and skin closure with the subcuticular closure. Most recently, the patient returned. She's now two years post-operatively from surgery. She's returned to tumbling in an active lifestyle with no elbow pain and a well preserved elbow joint with a well incorporated graft, as we can see in the images shown.

Allograft OATS® Technique for an Elbow Osteochondral Defect

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