Our 14-year-old son has been battling an elbow problem since he was 11. It’s called osteochondritis dissecans. He’s been in and out of therapy for that time, and he’s had two surgeries that didn’t work. A new surgeon in town has suggested trying something called mosaicplasty. What can you tell us about this procedure?

Osteochondritis dissecans (OCD) of the elbow is a condition in which the layer of joint cartilage just above the bone has separated and pulled away from the first layer of bone called the subchondral bone. The result is pain, swelling, and loss of motion — all of which lead to loss of function as well.

Mosaicplasty is a fairly new procedure for the elbow that has been used with good results for ankle and knee OCD. The surgeon removes any loose fragments of cartilage in the elbow. Any rough or frayed portions of the joint surface are shaved and smoothed down. Then the surgeon drills what look like tiny postholes in the articular surface of the elbow joint. Using plugs of bone harvested from the knee opposite the elbow, the holes are filled in and the surface smoothed over.

The donor plugs are taken from an area of the knee where there’s less pressure when standing and walking to avoid any knee problems. The holes left by removing the plugs are filled in with a special bone wax to prevent bleeding. Within two days, the patients are usually up and about putting partial weight on the knee and gradually returning to full weight-bearing status by the end of a week’s time. The elbow is placed in a cast in a position of 90-degree flexion for two weeks. This allows some time for healing before starting to move it again.

Rehab is a slow, but steady process that takes place over a period of six months to a year. X-rays and sometimes MRIs are used to evaluate the condition of the joint surface. A recent Japanese study of 19 teenage athletes with this condition who had elbow mosaicplasty reported good to excellent results for all the athletes. Only one athlete had (mild) residual pain after the procedure. A few chose to switch to a different sport, but all returned to the playing field with full elbow function.

The authors of that study concluded that mosaicplasty is a very good treatment choice for teenage athletes suffering from advanced osteochondritis dissecans of the elbow. The procedure may work best in younger players who have smaller defects requiring smaller grafts but more research is needed to confirm this finding. Although no one in the study showed any signs of osteoarthritis, long-term studies are still needed to see if there are later developments of this kind.