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Surgical approaches to the capitellum: a comparative anatomic study.

Nicolas Gallusser¹, Patrick Goetti², Geoffroi Lallemand²

¹Department of Orthopaedic and Trauma Surgery, Valais Hospital, Sion, Switzerland.

Journal of Shoulder and Elbow Surgery

|October 27, 2023

Summary

The posterior anconeus-splitting approach offers better exposure for osteochondritis dissecans (OCD) of the humeral capitellum than the Kocher approach. Combining both approaches provides complete joint surface visualization for elbow surgery.

Keywords:

Surgical approaches articular surface cadaveric study capitellum elbow osteochondritis dissecans

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Area of Science:

Orthopedic Surgery
Elbow Arthroscopy
Sports Medicine

Background:

Osteochondritis dissecans (OCD) of the humeral capitellum is a common cause of elbow dysfunction in young athletes.
Surgical reconstruction using osteochondral autograft may be necessary for large or unstable OCD lesions.
Various surgical approaches exist for capitellar OCD, with posterior anconeus-splitting and lateral approaches being most common.

Purpose of the Study:

To compare the exposed articular surface area of the humeral capitellum using the Kocher approach versus the posterior anconeus-splitting approach.
To evaluate the additional exposure gained by releasing the lateral ulnar collateral ligament (Wrightington approach).

Main Methods:

Three surgical approaches (Kocher, anconeus-splitting, Wrightington) were performed on 8 adult cadaveric elbows.
The visible articular surface of the capitellum was measured after each approach.

Main Results:

The posterior anconeus-splitting approach visualized 74% of the capitellar surface, significantly more than the Kocher approach (49%).
The Wrightington approach achieved 93% visualization.
Combining the Kocher and anconeus-splitting approaches allowed access to 100% of the joint surface.

Conclusions:

The anconeus-splitting approach is effective for posterior capitellar OCD lesions, while the Kocher approach is suitable for anterior lesions.
A combined approach provides complete visualization of the capitellar articular surface, beneficial for OCD treatment.