2021 Annual Meeting Wrist & Elbow Access Pass-Surgical Technique Spotlight: Arthroscopic OCD Repair (video demo)

Video Transcription

Video Summary

The video presents a detailed discussion and demonstration of surgical techniques for treating large osteochondral defects (OCD) and ulnar collateral ligament (UCL) tears in the elbow. The panel debates graft options for large cartilage lesions, comparing autografts (medial vs lateral trochlea) and allografts, highlighting donor site morbidity risks and challenges in obtaining specific allografts. For unstable, large, lateral OCD lesions without sufficient bone backing, the preference is grafting over debridement, often harvesting from the medial trochlea via arthroscopy, with attention to joint contracture and synovitis management.<br /><br />The presentation shifts to UCL reconstruction in a right elbow with a proximal tear, emphasizing careful surgical exposure to identify and protect the ulnar nerve and medial antebrachial cutaneous nerve branches. The surgeon describes incising the intermuscular septum at the epicondyle, splitting the flexor carpi ulnaris fascia to expose the ligament near its native attachment around the epicondyle corner, and locating the sublime tubercle on the ulna—a critical landmark for tunnel placement.<br /><br />Drilling tunnels are made in the sublime tubercle under direct visualization and nerve protection to prepare for graft fixation, with attention to preserving an overlying broad tendon that contributes to ligament tension. The epicondylar tunnels are similarly prepared with precise guides, creating an adequate bone chamber for graft placement. The discussion highlights the importance of anatomy, precise technique, and graft choice for optimal outcomes in cartilage repair and ligament reconstruction.

Asset Caption

Dr. John Conway | The Athlete's Elbow

Keywords

osteochondral defects

ulnar collateral ligament tears

elbow surgery

cartilage grafting

autografts vs allografts

UCL reconstruction technique

surgical anatomy landmarks