Outcomes of grafting extracellular matrix with bone marrow aspirate concentrate in pediatric and adolescent patients with capitellar osteochondritis dissecans

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, although 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 capitellar 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 Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, 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 patients (75%) were female. The most common primary sports were gymnastics, baseball/softball, and racquet sports. Flexion improved significantly at ≥1 year postoperation, whereas extension remained close to full pre- and postoperatively. PROs improved from pre- to postoperative for all assessed instruments except for the HSS Pedi-FABS, which was statistically no different. Eighteen patients returned to their primary sport at the same competitive level or higher at a mean 5.8 ± 1.2 months. The 2 patients who did not return to their primary sport changed sports because of preferences unrelated to their elbow. There were no complications (eg, 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 ≥1 year postoperatively with an ~90% RTS rate at an average of 5.8 months, 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 capitellar OCD lesions treated with ECM-BMAC grafting.