Three-dimensional suitability assessment of three types of osteochondral autograft for ulnar coronoid process reconstruction

• Published in: Journal of shoulder and elbow surgery Vol. 23; no. 2; pp. 143 - 150
• Main Authors: Kataoka, Toshiyuki, MD, PhD, Moritomo, Hisao, MD, PhD, Miyake, Junichi, MD, PhD, Murase, Tsuyoshi, MD, PhD, Sugamoto, Kazuomi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2014
• Subjects: Adolescent; Adult; Aged; Autografts; Bone Transplantation; Cartilage - transplantation; Coronoid process; Elbow Joint - diagnostic imaging; Elbow Joint - surgery; Female; Fractures, Comminuted - surgery; Humans; Imaging, Three-Dimensional; Male; Middle Aged; olecranon graft; Olecranon Process - transplantation; Orthopedics; radial head graft; reconstruction; Reconstructive Surgical Procedures; three-dimensional analysis; Tomography, X-Ray Computed; Ulna - diagnostic imaging; Ulna - surgery; Ulna Fractures - diagnostic imaging; Ulna Fractures - surgery; olecranon graft; radial head graft; three-dimensional analysis; Diagnostic Study; reconstruction; Coronoid process; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2013.10.004

Background Osteochondral autografts with use of the olecranon tip, lateral radial head, or proximal radial head have been employed for coronoid process reconstruction. However, it is unclear which autograft is most suitable for coronoid articular configuration. We assessed 3-dimensional articular facet suitability of 3 osteochondral autografts for coronoid process reconstruction. Methods We performed 3-dimensional computed tomography of 20 elbows to compare the articular facet configuration between the coronoid process and the ipsilateral olecranon tip, lateral radial head, and proximal radial head. We measured the area of the proximity region (≤2.0 mm) between the articular facets of the coronoid process and 3 osteochondral autografts, the covering rate defined as the percentage area of the coronoid articular facet occupied by the proximity region, the location of the proximity region center, and the percentage of the removed ulnohumeral articular facet. Results The covering rate was significantly higher with an olecranon graft than with radial head grafts. The regional center of a proximal radial head graft was significantly medial compared with that of olecranon and lateral radial head grafts. The olecranon graft used an average of 13.8% of the ulnohumeral articular facet. Conclusions An olecranon graft was most suitable for defects of the coronoid process involving the tip, and a proximal radial head graft was most suitable for defects of the coronoid process involving the anteromedial rim. The use of an olecranon graft for reconstruction of 50% of the height of the coronoid process does not cause concern for gross elbow instability.