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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-09-2021 | Osteochondrosis Dissecans | Arthroscopy and Sports Medicine

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

Authors: Sebastian Farr, Matthias Pallamar, Theresa Eder, Rudolf Ganger

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2021

Abstract

Introduction

Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting.

Materials and methods

Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24–45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected.

Results

All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165–200), 94 (range, 70–100), and 92 (range 83–98; normative score 47; range 35–55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, − 27–100%; 52%, 4–100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted.

Conclusion

This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.

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Title: Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients
Authors: Sebastian Farr
Matthias Pallamar
Theresa Eder
Rudolf Ganger
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keyword: Osteochondrosis Dissecans
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03773-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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