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.