Autologous chondrocyte implantation in osteochondral defects of the capitulum: clinical and radiological outcome in a case series.

BACKGROUND: Osteochondritis dissecans (OCD) of the capitellum is a cartilage and subchondral bone disorder predominantly affecting young, physically active individuals. While established surgical techniques such as microfracturing and osteochondral autograft transfer offer acceptable outcomes, limitations in cartilage quality or procedural invasiveness remain. Autologous chondrocyte implantation (ACI) has been proposed as a less invasive, biologically restorative alternative, though clinical data on its use in the elbow are not available. Therefore, the aim of this pilot study was to evaluate the feasibility of ACI for the treatment of elbow OCD in a case series. METHODS: In this prospective observational study, 6 male patients (20.5 ± 5.2 years) with centralized International Cartilage Research Society grade IV OCD lesions of the capitellum were included and treated with ACI. Clinical evaluations were performed at 6 months (T1), 12 months (T2), and 34.8 ± 7.9 months (T3) post-operatively, including assessment of range of motion, subjective elbow value, visual analog scale for pain, Mayo Elbow Performance Score, Kerlan-Jobe Orthopaedic Clinic score, and return to sport. Magnetic resonance imaging was conducted at T2 and T3, and cartilage repair tissue was analyzed using the magnetic resonance observation of cartilage repair tissue 2.0 Ankle Score. RESULTS: Improvements were observed across all clinical outcome measures. Subjective elbow value increased from 59 ± 18.5% pre-operatively to 91.2 ± 4.2% at final follow-up, while visual analog scale under load decreased from 6.5 ± 1.6 to 0.8 ± 0.7. Mayo Elbow Performance Score and Kerlan-Jobe Orthopaedic Clinic improved from 70.6 ± 17.7 to 97.5 ± 6 and from 38.3 ± 10 to 88.5 ± 8.4, respectively. Magnetic resonance imaging demonstrated defect filling and integration in all individuals, as assessed by the magnetic resonance observation of cartilage repair tissue score, which showed no deterioration between T2 and T3. The mean return to sport time was 6.8 ± 3 months. No complications or need for revision surgery were recorded. CONCLUSION: This pilot feasibility study provides preliminary insights into the treatment of centralized capitellar OCD lesion with ACI in a case series of young, active patients, with clinical and radiological findings at a mean 3-year follow-up (range, 25-42 months). These exploratory findings suggest that ACI may warrant further investigation for focal, symptomatic elbow defects with minimal or limited involvement of the subchondral bone. Larger controlled studies are needed to define the role of ACI relative to established treatment options.