Using Patient's Own Tissue to Treat Loose Growths in the Elbow
Patients who have osteonecrosis (death of bone tissue) or osteochondral lesions (loose growths) in the elbow present a challenge to doctors. Treatments that have been used include debriding, or clearing the area of dead tissue, or microfracture, which involves drilling small holes in the bone next to the lesions so bone marrow can seep out and seal the area. However, these treatments do not appear to be long-term solutions.
The authors of this study reviewed the best methods to treat this problem. Patients who present with osteochondral lesions are usually children between six and 10, who have Panner disease, or adolescents and young athletes who use their arm in repetitive and strong, forceful motions. The patients complain of pain with use, stiffness, pain at night, inability to move the elbow freely, and sometimes a clicking sound from the elbow.
After diagnosing the problem through x-ray, the doctors must stage the damage. Earlier discovery and staging can be done through magnetic resonance imaging (MRI). If the doctors determine the staging to be stage I or II, surgery is usually not performed. Nor is surgery performed on patients with Stage III or IV if the symptoms have only been present for six months or less. The patients who do undergo surgery often do not have long-term relief and may be at higher risk of developing arthritis in the elbow later on in life.
The researchers looked at seven patients who were treated with a transplantation of tissue from the patient's knee and implanted into the affected elbow. The three females and four males ranged in age from 15 to 21 years. Five patients were active in competitive sports and the other two in recreational sports. All had stage III or IV level lesions and had tried previous treatment. Pain was assessed through the American Shoulder and Elbow Surgeons (ASES) form; elbow functioned was assessed by the Broberg and Morrey Score. The patients were followed for between 42 and 83 months.
The results showed the patients experienced a significant decrease in pain following the surgery as was their ability to extend their elbow fully. MRIs performed at follow up showed that the grafts healed well.
The authors conclude that the mid-term findings at two years are promising with overall good to excellent results.
References: Patrick Ansah, MD, et al. Osteochondrol Transplantation to Treat Osteochondral Lesions in the Elbow. In Journal of Bone and Joint Surgery. October 2007. Vol. 89A. No. 10. Pp. 2188-2193.Back