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Morrey Award 2023: Radial Head Donor Plug for Capitellum Osteochondral Autograft Transfer: A Cadaveric Biomechanical Analysis
Journal article   Open access   Peer reviewed

Morrey Award 2023: Radial Head Donor Plug for Capitellum Osteochondral Autograft Transfer: A Cadaveric Biomechanical Analysis

Bryan G. Adams, Jeremy Tran, Steven Voinier, Donald F. Colantonio, Michael A. Donohue, Kelly G. Kilcoyne and Joseph W. Galvin
JSES international, Vol.8(6), pp.1157-1163
11/2024
DOI: 10.1016/j.jseint.2024.07.007
PMCID: PMC11733562
PMID: 39822848
url
https://doi.org/10.1016/j.jseint.2024.07.007View
Published (Version of record) Open Access

Abstract

Limitations to using the knee as donor cartilage include cartilage thickness mismatch and donor site morbidity. Utilizing the radial head as donor autograft for capitellar lesions may allow for local graft harvest without distant donor site morbidity. The purpose of this study is to demonstrate the feasibility of performing local osteochondral autograft transfer from the non-articular cartilaginous rim of the radial head to the capitellum. Additionally, we sought to determine the load to failure of the radial head after harvest. Sixteen matched cadaveric elbows were utilized. A Kaplan approach was performed in half of the specimens and an extensor digitorum communis (EDC) split in the other half. 6mm and 8mm capitellar cartilage defects were created. A donor plug was harvested from the rim of the radial head and transferred to the capitellum. In half of the specimens, the donor site was backfilled with autograft from the recipient plug. The other half were backfilled with calcium-phosphate cement. The radial head was removed from the specimen and biomechanical analysis performed. Both surgical approaches had adequate exposure to access the lateral 2/3 capitellar lesions in all specimens. The medial third of the capitellum was less accessible in EDC split approaches (1/8) compared to the Kaplan approach (6/8 p = 0.01). The average cartilage thickness of the peripheral rim of the radial head and capitellum was 2.5mm (range 1.8-3.2, SD 0.4) and 2.2mm (range 1.8-3, SD 0.3), respectively. During the procedure, 2 of 8 radial heads fractured in the 8mm plug group. No radial heads fractured in the 6mm group (p = 0.47). Biomechanical testing demonstrated a mean load to failure of 1993N with no difference between groups when stratified by donor plug size or type of backfill. This study demonstrates that the non-articulating peripheral cartilaginous rim of the radial head could be a local harvest site for osteochondral autograft transfer for capitellar lesions up to 8mm in diameter. The cartilage thickness of the radial head closely approximates the capitellum. Biomechanical analysis did not demonstrate a significant difference in load to fracture when backfilling the radial head harvest site with autograft bone or calcium phosphate cement. After harvest, the radial head could withstand forces much greater than those seen across the elbow when non-weight bearing. Further investigation is needed to determine how to mitigate the risk of iatrogenic fracture with this operation.
 capitellum elbow cartilage osteochondral autograft transfer osteochondral defect osteochondritis dissecans radial head

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