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Osteochondral coronoid allograft in chronic coronoid process bone loss reconstruction: an original technique with encouraging clinical and radiological outcomes at a mid-term follow-up
  1. Luigi Adriano Pederzini1,
  2. Matteo Bartoli2,
  3. Andrea Cheli1
  1. 1Orthopaedics and Traumatology Unit, Nuovo Ospedale Civile di Sassuolo, Sassuolo, Italy
  2. 2Orthopaedics and Traumatology Department, Università Cattolica del Sacro Cuore - Fondazione Policlinico Gemellisita Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
  1. Correspondence to Dr Matteo Bartoli, Orthopaedics and Traumatology Department, Università Cattolica del Sacro Cuore - Fondazione Policlinico Gemelli, Roma 00168, Italy; matteobartoli1{at}gmail.com

Abstract

Objectives Ulnar coronoid apophysis is a primary stabiliser of the elbow; a relatively small amount of bone loss, quantifiable in 40%, could be sufficient to make an elbow incongruent. If coronoid fixation is not possible, the only way of achieving a stable elbow is to reconstruct it. This case series describes the senior author’s original surgical technique in reconstructing the coronoid with a fresh-frozen osteochondral coronoid allograft, reporting a mid-term follow-up (average of 55.5 months, minimum of 26 months) of four patients (described one by one) with subjective and objective outcomes.

Methods The senior author operated on four patients with his original surgical technique, fully explained in the text. The mean follow-up at the time is 55.5 months (up to 10 years in one case). Preoperatively and postoperatively, the patients were asked to answer three types of validated scales: Visual Analogue Scale (VAS), Quick-Disabilities of the Arm Shoulder and Hand (Quick-DASH) and Mayo Elbow Performance Index (MEPI). All patients underwent preoperative X-rays and CT scans. Afterwards, they were asked to have further X-rays and a dual- energy CT scan in the last-follow up.

Results Three patients achieved 100 points on the MEPI scale. Three patients achieved full range of motion (ROM), while the fourth one easily achieved functional ROM. The VAS score mean improvement was 50%, and two patients were completely pain-free; the Quick-DASH average improvement score was 56.82 points.

Conclusions This case series presents an original technique using a coronoid allograft. Three of four patients achieved full ROM, and two were pain-free at follow up. Everyone resumed previous levels at work and in sports. The good outcomes suggest that this procedure seems to be safe and does not necessarily require autologous structures. The lack of registered cases of graft reabsorption may encourage the use of an osteochondral coronoid allograft.

Level of evidence Level IV.

  • elbow
  • instability
  • allograft
  • bone

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Footnotes

  • Contributors LAP invented the described surgical technique and operated on the included patients. LAP and MB planned the study, enrolled the patients, checked them at follow-up and collected the results. MB has written the paper, cooperating with AC, who has built the Medline.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval IRB approval was not deemed necessary considering the type of study and the standard postoperative follow-up timing and imaging.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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