First Study to Report Long-Term Results of OAT Treatment for the Elbow

Athletes involved in lifting heavy weights, repetitive elbow motions, or overhead activities are at risk for a condition called osteochondral lesions. Osteochondral lesions refer to damage or defects to the joint cartilage (chondral) that go all the way down to the first layers of bone (osteo). Holes in the osteochondral layer and/or loose fragments of bone and cartilage in the joint can cause pain, locking of the joint, and eventually osteoarthritis.

There are many ways to treat this problem starting with conservative (nonoperative) care. But when six months or more of conservative care does not yield the desired results, then surgical treatment is considered. The surgeon may remove the fragments and smooth the area over with a special surgical shaver. This procedure is called debridement.

Other surgical options include reattachment of the fragments, microfracture (drilling tiny holes to stimulate healing), or osteotomy (removing a wedge of bone to close up the hole). Most of these techniques don't work as well as hoped and there is a high risk of osteoarthritis later.

That's why the surgeons from Germany who published this study are still pursuing a new approach called osteochondral autograft transfer. They have studied and written about the short- and mid-term results of this treatment for a group of eight patients. This is a continuation of those studies with follow-up eight to 14 years after surgery.

Osteochondral autograft transfer (OAT) involves removing a plug of cartilage and bone from a healthy area (in this case from a non-weight bearing area of the knee) and transferring it into the osteochondral lesion (i.e., hole in the surface of the same patient's elbow joint). The word "autograft" refers to the fact that the patient donates his or her own tissue for the procedure.

The group being studied and followed long-term consisted of four men and four women between the ages of 15 and 21. All were athletes engaged in competitive sports including volleyball, soccer, gymnastics, tennis, basketball, and skiing. All had "failed" six months or more of conservative care. Failure of nonoperative care means despite all efforts, pain, decreased elbow motion, and loss of function persisted.

As with the other surgical techniques to treat this problem, there is concern that degenerative changes will occur years later causing painful and debilitating osteoarthritis. In this study, the patients were followed at regular intervals to measure and observe results. X-rays, MRIs, pain analysis, and the American Shoulder and Elbow Surgeons (ASES) score were used to assess condition of the damaged elbow joint, pain levels, range of motion, and function.

Results were considered excellent. MRIs showed good coverage of the defects with full incorporation of the graft. Some slight changes were seen with mild bone edema (swelling) in one patient and bone cysts in two others. But the joint space was open and free for each patient and only two patients had any signs (all mild) of osteoarthritis 10-years later.

All eight patients were pleased enough with the procedure they said they would have the same surgery again if given the choice. They were all able to return to sports without any limitations. The biggest problem reported was knee pain from the donor graft site but this wasn't enough to stop them from doing what they wanted to do in terms of daily activities or sports participation.

The surgeons concluded that the use of osteochondral autograft transplantation (OAT) is a successful treatment option for severe osteochondral lesions of the elbow. The overall long-term results were better for this treatment than results reported for other treatment approaches (e.g., microdrilling, debridement).

This treatment is also an option for patients who have tried other surgical treatments that failed to bring satisfying results. The goal of returning to full participation in sports was met. Those patients who changed sports activities or level of participation did so because of age or work requirements, not because of the previous elbow injury.

The authors make note of the fact that their study did not include baseball players engaged in repetitive throwing motions. Since osteochondral elbow lesions are fairly common in this group of athletes, a similar study is needed to see if the results would be equally good in that patient population.

Reference: Stephan Vogt, MD, et al. Osteochondral Transplantation in the Elbow Leads to Good Clinical and Radiological Long-Term Results. In The American Journal of Sports Medicine. December 2011. Vol. 39. No. 12. Pp. 2619-2625.

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