Elbow osteochondritis dissecans - Osteochondral autograft transfer (OATS procedure)

Osteochondritis Dissecans (OCD) is a joint condition in which the bone and cartilage underneath a joint die from a lack of blood flow. This causes the bone and cartilage to break away, resulting in pain and a hindering of the joint movement.  OCD commonly occurs in highly active adolescents, particularly those participating in a sport which involves intense repetition of the joints such as in throwing ball sports and gymnastics.

In Osteochrondral Autograft Transfer Surgery, or OATS as it is commonly referred to, the cartilage and bone are removed from a healthy non-weight bearing area of a patient’s knee and transferred and grafted to the area, such as the elbow. Please see here for articles published by Kemble Wang on elbow OCD and OATS.

Below is an x-ray of a patients with OCD changes to the capitellum of the elbow.

elbow OCD as seen on xray.

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

 

Following surgery for OCD on the elbow, and for the initial two weeks, the arm will be in a back-slab to immobilise the elbow.  Keep all dressing/bandages intact and dry until the first post-operative appointment with Kemble. A plastic bag tied above the elbow to prevent the arm from getting wet can be used during showering, or alternatively a one-handed bath can be taken. Kemble will review the wound and advise when it is safe to get it wet.

 

0-2 weeks after surgery

  • The arm should be elevated as much as possible to reduce swelling. A pillow can be used to prop up the arm when seated or lying down;

  • Finger, wrist and assisted/supported shoulder movements should commence to avoid stiffness

  • For the leg - can weightbear as tolerated with help of a crutch, start range of motion for knee

Weeks 2-6 post surgery:

  • At initial post-operative appointment:

    • Post-operative backslab to be removed and the wound dressed;

    • Tubigrip (or similar) to be applied to the elbow to reduce post-operative swelling;

    • Scar management to commence if suitable;

    • All active elbow ROM initiated but weightbearing or lifting more than 1kg should be avoided;

    • Sling to remain other than for hygiene purposes and exercises.

    • Crutch can be ceased, push for full range of motion for knee

 

Weeks 6-12 post surgery:

  • Sling removed with a plan to achieve full ROM.

  • Start quads strengthening for knee

Week 12+

  • Weightbearing to be increased to 5kg;

  • Strengthening and conditioning exercises of the shoulder, elbow, forearm and wrist to commence;

  • Full upper limb biomechanics to be reviewed, and any compensations noted and rehabilitated;

  • Exercises to work on range of motion deficits to continue;

  • Repeat MRI at 6 months postoperatively.

Return to activity

  • The speed of healing and a return to sports timetable will be different for every patient. However, generally, this will only occur six months post the operation and not before a repeat MRI is undertaken. This is to enable the area to heal sufficiently and ensure that strength and stability have returned. A physiotherapist will advise on sports specific strengthening exercises to assist with the transition.

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for specific advice from either Kemble Wang or your other healthcare practitioners