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Elbow osteochondritis dissecans - Osteochondral autograft transfer (OATS procedure)​

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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.

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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.

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

elbow OCD.png

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

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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

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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.

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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.

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