Outcomes of Concentrated Bone Marrow Aspirate with Extracellular Matrix in Pediatric and Adolescent Patients with Capitellar Osteochondritis Dissecans.

Abstract

Background: Humeral capitellar osteochondritis dissecans (OCD) lesions can be challenging to treat. Past studies have demonstrated grafting with extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) to be a viable technique for treatment of talar dome OCD, though little literature exists regarding application of this technique to the capitellum. This study aimed to report patient-reported outcomes (PROs) and return to sport (RTS) of pediatric patients at ≥1-year postoperatively who underwent ECM-BMAC grafting for capitellar OCD lesions.

Methods: A consecutive, single surgeon series of patients aged <18 years with unstable, contained humeral capitellum OCD who underwent ECM-BMAC grafting and had ≥1-year of clinical follow-up were included. Elbow range of motion (ROM), RTS time, postoperative sport level, and complications were recorded at follow-up visits. PROs, including Hospital for Special Surgery (HSS) Pedi-FABS, QuickDASH, Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility, PROMIS Pain Interference, and PROMIS Upper Extremity, were obtained at baseline and ≥1-year postoperatively. Both PROs and ROM were compared pre- and postoperatively using Wilcoxon Signed-Rank tests based on normality testing with Shapiro-Wilk tests.

Results: Twenty patients were included (mean age 12.8 ± 1.4 years) with an average 22.2 ± 13.0 months follow-up. Fifteen (75%) patients were female. The most common primary sports were gymnastics, baseball/softball, and racquet sports. Flexion improved significantly at ≥1-year postoperative, while extension remained close to full pre- and postoperatively. PROs improved from pre- to postoperative for all assessed instruments except for the HSS Pedi-FABS. Eighteen patients returned to their primary sport at the same competitive level or higher at a mean 5.8 ± 1.2 months. The two patients who did not return to their primary sport changed sports due to preferences unrelated to their elbow. There were no complications (e.g. infection, stiffness, revision surgery).

Conclusions: This study demonstrated that ECM-BMAC grafting is a viable treatment strategy for pediatric patients with unstable, contained capitellar OCD lesions. We observed favorable PROs with a ∼90% RTS rate ≥1-year postoperatively, supporting the results of this technique that has demonstrated success in other anatomic regions and adult populations. These findings suggest ECM-BMAC grafting to be a viable treatment option for contained capitellar OCD lesions. Although these early results are promising, longer-term research studies are paramount in determining the outcomes of patients with capitellum OCD lesions treated with ECM-BMAC grafting.