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Veterinary Surgery
38:246–260, 2009

Early Clinical Experience with Osteochondral Autograft Transfer for

Treatment of Osteochondritis Dissecans of the Medial Humeral
Condyle in Dogs

NOEL FITZPATRICK, MVB CertSAO CertVR, RUSSELL YEADON, MA VetMB, and THOMAS J. SMITH, MA VetMB CertSAS

Objective—To establish whether osteochondral autograft transfer (OAT) procedures for

osteochondritis dissecans (OCD) of the canine elbow would restore articular contour, resurface
osteochondral defects with hyaline cartilage, and resolve lameness in the short term.
Study Design—Case series.
Animals—Dogs (n ¼ 27) with medial humeral condylar OCD.
Methods—After arthroscopic assessment, the medial humeral condyle was exposed by arthrotomy.
Medial coronoid disease (MCD) was managed by subtotal coronoid ostectomy, then the OCD
lesion debrided and OATSt instrumentation used for resurfacing the defect with osteochondral
core grafts collected from the stifle. Recipient sockets were created to maximally resurface OCD
lesions. Six elbows also had proximal ulnar osteotomy. Outcomes measures included subjective
clinical, radiographic, and arthroscopic examination at 12–18 weeks.
Results—Of 33 treated elbows, 30 also had MCD. Accurate reconstruction of the medial humeral
condylar surface was achieved in all joints. Lameness resolved in 3–13 weeks in 26 of 31 limbs with
follow-up. Arthroscopic outcomes for elbows with concomitant MCD but without proximal ulnar
osteotomy were variable (14/24 good, 5/24 intermediate, 5/24 poor). Short-term outcome for OCD
without MCD (n ¼ 2) and when proximal ulnar osteotomy (n ¼ 5) was performed were positive.
Long-term assessments of 7 dogs suggested minimal donor site morbidity.
Conclusions—OAT procedures are technically feasible in the canine elbow. In elbows with con-
current MCD, proximal ulnar osteotomy may improve likelihood of positive clinical outcome.
Clinical Relevance—OAT procedures warrant further evaluation as a treatment option for selected
cases of OCD involving the canine medial humeral condyle.
r Copyright 2009 by The American College of Veterinary Surgeons

INTRODUCTION sent a disturbance of endochondral ossification with

failure of deeper cartilage layers to mature and mineralize

O STEOCHONDROSIS (OC) of the medial humeral

condyle is commonly recognized as a component of
a group of diseases known as ‘‘elbow dysplasia’’ and is an
important cause of thoracic limb lameness in the dog.
The cause and pathogenesis of OC is incompletely un-
derstood and appears to be multifactorial, with genetic,
dietary, growth rate, endocrine, traumatic, and morpho-
metric factors implicated.1–7 OC is understood to repre-
appropriately with resultant thickening of articular car-
tilage.8 Progression of lesions to osteochondritis disse-
cans (OCD) by cleavage or fracture of abnormal cartilage
results in effusion, synovitis, subchondral edema, sclero-
sis, and degenerative joint disease (DJD) causing pain
and lameness.9
Concurrent disease involving the medial aspect of the
coronoid process (MCD) and OCD is recognized and

From Fitzpatrick Referrals, Eashing, UK

This project did not receive external financial support and there is no proprietary interest.
Address reprint requests to Noel Fitzpatrick, MVB CertSAO CertVR, Fitzpatrick Referrals, Halfway Lane, Eashing, Surrey GU7
2QQ, UK. E-mail: noelF@fitzpatrickreferrals.co.uk.
Submitted March 2008; Accepted October 2008
r Copyright 2009 by The American College of Veterinary Surgeons

0161-3499/09
doi:10.1111/j.1532-950X.2008.00492.x
246

FITZPATRICK, YEADON, AND SMITH
clinical diagnosis and treatment of these 2 disorders are
often considered together.10,11 Although no significant
variation in outcome between surgical and nonsurgical
therapies10 or between different surgical treatment mo-
dalities has been reported, surgical therapy is commonly
perceived to offer an improved prognostic outcome, par-
ticularly for dogs with chronic or refractory lameness
of moderate or marked severity.12
Surgical treatment of OCD has typically included
removal of the cartilage flap, followed by debridement or
osteostixis of underlying subchondral bone to stimulate
fibrocartilaginous ingrowth.13 Bouck et al reported that
whereas most dogs improve clinically with surgical
management, most continue to have lameness and all
have progressive and inexorable DJD,10 which in our
experience is commonly markedly debilitating, justifying
investigation of alternative treatment approaches.
Osteochondral autograft transfer (OAT) procedures
involve transplantation of one or several cylindrical cores
of undiseased articular cartilage and underlying sub-
chondral bone from a region of limited load bearing to an
osteochondral defect in a load-bearing area. OAT pro-
cedures are widely used for osteochondral resurfacing in
human joints with validated clinical outcomes over 10
years.14–16 Viability in canine joints has been established,
clinically in the stifle and experimentally in various
joints.17–21 Putative benefits of OAT procedures over
conventional techniques include accurate reconstruction
of subchondral and articular contour, resurfacing with
hyaline or hyaline-like cartilage, and creation of an im-
mediate barrier between synovial fluid and subchondral
bone. OAT procedures have a superior outcome com-
pared with microfracture for treatment of articular
cartilage defects in the knee of human athletes.22
In juvenile athletic human patients with OCD of the
elbow, OAT procedures have been used with some
success,23,24 although biomechanical and functional
differences between human and canine elbows prevent
direct comparison. OAT procedures are considered
readily transferable clinically to dogs (compared with
common alternative resurfacing techniques) because they
can be completed within a single operative session,
require relatively inexpensive instrumentation, and are
known to be viable in canine joints.19–21
Morbidity associated with donor harvesting has been
raised as a potential major concern,17 particularly when
transferring osteochondral cores from a healthy stifle
joint to another diseased joint like the elbow. Osteochon-
dral core harvesting from a recipient joint (e.g, stifle) or
from a distant donor site of minimal anatomic impor-
tance21 would be considered ideal. No such site has been
established for the canine elbow and knowledge of the
normal contact areas in the undiseased canine elbow25
suggests that identification of such a site within the elbow
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247
is unlikely. Donor sites from the canine stifle have been
established and currently represent the only reliable
available source of canine donor osteochondral auto-
graft material.
Concerns about donor osteochondral graft collection
from the human knee have not proven clinically sig-
nificant in the medium term.24,26 Where identified in hu-
mans, there has been suggestion that short-term morbid-
ity may be largely attributable to patellar instability or
other problems associated with arthrotomy closure.27
Long-term morbidity of 3% (assessed by the Bandi scor-
ing system) has been reported for mosaicplasty
OAT procedures,28 and long-term morbidity in knee-
to-other joint procedures was reported only ‘‘with rare
exception.’’ Where identified in this circumstance, donor
site complications resolved within 6 weeks in 95% and
within 1 year in 98% of cases. Despite these findings,
some osteoarthritis might be expected as an inevitable
long-term sequel but to our knowledge, no studies
specific to OAT donor morbidity in canine stifles exists
whereby species differences could be compared.
Whereas potential donor site morbidity must be con-
sidered as a major concern, violation of an undiseased
joint from a distant anatomic site may be considered
ethically acceptable where the disease process being
treated is anticipated to be more debilitating than the
anticipated donor morbidity. The same ethical concerns
must be addressed as for other commonly-performed
veterinary autologous tissue grafting such as cancellous
bone grafting,29 free skin or paw pad grafting,30 or less
common procedures like fascia lata grafting,31 microvas-
cular muscle transfer,32 bone grafting,33 or omental
grafts.34 Stifle-to-other joint clinical OAT procedures
have been reported in horses following these ethical
guidelines.35 We considered that in the debilitating cir-
cumstance of OCD of the medial humeral condyle in
dogs, a level of potential morbidity like that described in
humans or horses would be ethically acceptable.
We hypothesized that therapeutic application of OAT
procedures for naturally-occurring OCD of the canine
elbow would accurately restore articular contour, resur-
face osteochondral deficits with hyaline cartilage, allow
rapid return to function, and resolve lameness in the
short term, with minimal donor site morbidity.
MATERIALS AND METHODS
Records (July 2004–September 2007) of clinical, radio-
graphic, and arthroscopic findings of all dogs that had OAT
for OCD of the medial humeral condyle were reviewed. All
dogs had thoracic limb lameness attributable to elbow disease
including OCD of the medial humeral condyle. Data retrieved
included signalment; severity and duration of preopera-
tive lameness; surgical details; clinical, radiographic, and

248 OSTEOCHONDRAL AUTOGRAFT TRANSFER
arthroscopic short-term (12–18 weeks) outcomes; and com-
plications where available.
Preoperative Evaluation
Historical information was recorded where available from
owner anamnesis and referring veterinary surgeon records,
including severity and duration of lameness, previous trau-
matic events, previous management and corresponding re-
sponses. Preoperative examination (by N.F.) included general
physical examination, subjective evaluation of lameness, as-
sessment of discomfort on joint manipulations, and evaluation
for presence of effusion or joint crepitus.
Preoperative owner counseling included discussion of non-
surgical and traditional surgical methods, and OAT proce-
dures. All 3 therapeutic approaches were offered to owners
and putative risks and benefits of each approach explained
incorporating provision of a written description and abbrevi-
ated interpretative summary of published literature for each
available method. All owners were made aware that OAT
procedures are not yet a recognized therapeutic technique in
dogs with no validated clinical outcomes data. Written owner
consent was provided to perform OAT before arthroscopic
evaluation. Discussion of, and written consent for treatment
of, concomitant MCD was also established when MCD was
suspected from preoperative evaluation including radiography.
Radiography
Minimum preoperative radiographic assessment performed
under general anesthesia included flexed mediolateral, ex-
tended mediolateral and extended craniocaudal radiographs
of both elbow joints, mediolateral radiographs of both shoul-
der joints, and mediolateral and caudocranial radiographs of
both stifle joints. Stifles were confirmed to be free of signs of
joint effusion or osteophytosis, as potential donor sites with
the exception of 3 stifles concomitantly affected by OCD of
the medial or lateral femoral condyle. Elbow osteophytosis
was scored using an ordinal scale (Table 1) based on that used
by the International Elbow Working Group (IEWG) by a
single investigator (R.Y.).
Arthroscopy
Preoperative arthroscopic assessment (N.F.) using stan-
dard medial portal placement with a 301 forward-facing 2.7-
mm arthroscope (Storz, Tuttlingen, Germany) connected to a
Table 1. Osteophytosis Scoring System
Osteophytosis
Score Radiographic Finding
0 Lack of osteophytosis, subtrochlear sclerosis may be
present
1 Osteophytosis in 1 or more locations under 2 mm
height
2 Osteophytosis in one or more locations 2–5 mm height
3 Osteophytosis in one or more locations 45 mm height
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Table 2. Modified Outerbridge Scoring System used for Arthroscopic
Evaluation of Cartilage Pathology
Modified Outerbridge Score Description of Gross Cartilage Quality
0 Normal
1 Chondromalacia (assessed by use of an
arthroscopic probe)
2 Partial thickness fibrillation
3 Deep fibrillation
4 Full thickness cartilage loss
5 Subchondral bone eburnation
video camera and image recording device confirmed presence,
location, and approximate size of the OCD lesion and allowed
identification of concomitant disease processes. A modified
Outerbridge score36 for cartilage disease (Table 2) was as-
signed to both the surface of the medial aspect of the coronoid
process (MCP) and the articular surface of the medial humeral
condyle surrounding the primary OCD lesion. Other findings
recorded included presence of fissuring or fragmentation of
the MCP, location, approximate size, and severity of other
cartilage pathology and subjective measures of synovitis and
variation in indentation stiffness of articular cartilage as de-
termined by palpation using a fine arthroscopic probe.
Selection Criteria
Inclusion criteria were: (1) written owner consent to per-
form an OAT procedure; (2) subjective presence of lameness
and pain localized to the elbow joint; (3) elbow pathology
attributable to OCD of the medial humeral condyle with or
without concomitant MCD as identified by a combination of
radiography and arthroscopy; and (4) an OCD lesion 45 mm
in minimum diameter Dogs were excluded from OAT if (1)
presence of cartilage pathology of modified Outerbridge grade
3 or higher associated with the medial humeral condylar ar-
ticular surface adjacent the primary OCD lesion for a distance
of 43 mm, or associated with the proximal radial articular
surface or lateral humeral condyle (identified arthroscopically),
suggestive of advanced DJD; (2) skeletally mature patients
(412–20 months old depending on breed) where significant
preexisting DJD would be anticipated; and (3) presence of
other clinically significant elbow disease (including ununited
anconeal process, incomplete ossification of the humeral con-
dyle and septic arthritis) as identified by radiography, arthros-
copy, or ancillary diagnostic tests where clinically indicated.
Surgical Technique
The initial group of dogs was treated between July 2004
and January 2007. Based on suboptimal outcomes in this ini-
tial group of dogs we modified the technique to include prox-
imal ulnar osteotomy after January 2007.
Group 1. Dogs had surgery between July 2004 and Jan-
uary 2007. Transplantation was performed using the OAT
System (OATSt, Arthrex, Naples, FL). Elbow arthrotomy
was performed immediately after arthroscopic assessment. A
3–4 cm skin incision was made over the craniomedial aspect of

FITZPATRICK, YEADON, AND SMITH
the humeral condyle and the subcutaneous tissues sharply
dissected. Blunt separation of the flexor carpi radialis/pro-
nator teres and superficial/deep digital flexor muscles caudal
to the medial collateral ligament allowed access to, and sharp
incision through, the medial aspect of the joint capsule using a
#11 scalpel blade. The limb was held over a large sand-bag
positioned under the lateral aspect of the elbow to act as a
fulcrum, facilitating inspection of medial joint compartment
structures. The use of 2–4 Gelpi self-retaining retractors main-
tained retraction of extracapsular structures.
When identified arthroscopically, MCD (including frag-
mentation, fissuring, or cartilage pathology ¼ modified Out-
erbridge grade 2 or higher) was treated by subtotal coronoid
ostectomy (SCO) using an air powered oscillating saw with a
5.8 mm blade (2m141, MDM Medical, North Baddesley,
UK). The osteotomy traversed the MCP from its medial bor-
der to the most caudal extent of the radial incisure cranial to
the sagittal ridge of the ulnar trochlear notch. The cut was
angled distocranially creating a pyramidal segment when the
MCP was grossly intact. The segment was separated from an-
nular ligament attachments and removed en bloc in addition to
any loose fragments.
Loose cartilage flaps associated with medial humeral con-
dylar OCD were excised and grossly diseased cartilage
debrided using a curette, leaving edges perpendicular to the
articular surface. OATSt sizer/tamps (variably-sized flare-
tipped template rods) were used to determine the size and
number of grafts required to cover each defect, either as single
transplants or in a mosaic-like pattern of smaller diameter
cores in best-fit combination. Recipient sockets were prepared
by reaming with the OATSt cannulated recipient site drill bit
of appropriate diameter (Fig 1A), threaded over the OATSt
Beath pin driven through the center of the lesion, perpendic-
ular to the articular surface. Copious lavage with sterile iso-
tonic fluid was used during reaming to minimize thermal
concentration at the bone–drill interface, and suction was ap-
plied to remove bone swarf.
Socket depth and graft insertion angle were assessed using
the calibrated OATSt alignment rod (Fig 1B) allowing accurate
matching of donor core and recipient socket. The dilator tamp
Fig 1. (A) Reaming of first recipient socket. Note perpendicularity of instrumentation to articular surface. (B) OATSt alignment
rod used to determine depth of recipient socket and to impact base of socket.
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249
was used to impact the base of the recipient socket by gentle
tapping with a mallet, maximizing recipient–core contact.
Donor cores were harvested from the stifle through a lim-
ited medial parapatellar approach, either from the abaxial as-
pect of the proximal medial trochlear ridge (Fig 2A) or from
the umbonate plateau region immediately mediodistal to the
intersect of the cranioproximal medial femoral condyle and
the distal medial trochlear ridge (plateau intersect of condyle
and trochlea–[PICT]; Fig 2B) which lies abaxial to the sulcus
terminalis region described for human OAT procedures.
Donor core harvesting was achieved by driving the OATSt
donor harvester trephine of appropriate diameter (1 mm wider
than the recipient socket diameter) with a mallet into bone to a
depth 2–3 mm greater than the preprepared recipient bed.
Donor harvesters have 4 longitudinal beveled windows cut as
slots circumferentially that present louvered fins on the inner
surface of the chisel cylinder. The slots facilitate judgment of
depth and are designed to engage the osteochondral cores for
twist-out extraction. The cylindrical bone core was detached
at the base by sharp axial rotation of the chisel through 901.
When axial rotation failed to free the bone core, ‘‘toggling,’’ a
rocking movement perpendicular to the long axis of the
osteochondral core, was used.
The core was carefully ejected from the harvesting chisel
(Fig 2C), examined for damage, and trimmed when necessary
to the same depth and shape as the recipient socket using a
scalpel blade or rongeurs. It was then manually press-fit into
the socket, initially holding the core gently with small forceps,
to a position where subtle variation in contour could be
match-optimized and alignment with the socket confirmed.
An OATSt sizer/tamp 1 mm wider than the diameter of the
socket was placed over the core in alignment with the socket
(Fig 3A). Gentle percussion using a small mallet allowed final
positioning (Fig 3B) of the core when final positioning by
digital pressure alone could not be achieved. Careful tamping
technique is considered to be crucial to maintenance of car-
tilage morphology and chondrocyte survival37 and use of this
technique was avoided or minimized where possible.
If 41 core was transplanted, the 1st was transferred and fully
inserted before creating recipient sockets for subsequent cores to

250 OSTEOCHONDRAL AUTOGRAFT TRANSFER
Fig 2. (A) Osteochondral core being harvested from medial
condylar ridge of stifle using OATSt harvester trephine (1 mm
greater diameter than recipient socket). (B) Cadaver dissection
demonstrating PICT donor site for OAT graft. (C) Osteo-
chondral core after ejection from cylindrical harvesting chisel.
Core is trimmed to premeasured length to match recipient
socket. PICT, plateau intersect of condyle and trochlea; OAT,
osteochondral autograft transfer.
avoid destabilization of the recipient structure and to maximize
accuracy of fit. Care was taken to avoid excessive convergence
of the bases of recipient sockets and to avoid damage to, or
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‘‘spin-out’’ of, cores already placed by subsequent adjacent
reaming. Overlap of cores was used where required to optimize
resurfacing of the lesion. Routine closure of both donor and
recipient sites was performed after joint lavage.
Group 2. Dogs had surgery between January and Sep-
tember 2007. In addition to the surgical technique used for
group 1, proximal ulnar osteotomy was performed after com-
pletion of intraarticular procedures.
A proximal (typically 3–6 cm distal to the proximal radial
articular surface) ulnar osteotomy was performed through a
limited caudal approach to the shaft of the ulna. The ulnar
head of the flexor carpi radialis and ulnaris lateralis muscles
were subperiosteally elevated and retracted. The osteotomy
was directed obliquely, both caudoproximal to craniodistal
(  401 to the long axis), and proximolateral to distomedial
(  501 to the long axis).
Postoperative Care
A self-adhesive wound dressing (Primaporet, Smith and
Nephew, Hull, UK) was applied to the surgical sites and
maintained for 2 days postoperatively. No additional ban-
daging or external coaptation was used at either donor or
recipient sites. Analgesia was titrated to individual dog re-
quirements with methadone (0.2 mg/kg intramuscularly [IM]
every 4–6 hours as needed) or buprenorphine (0.02 mg/kg IM
every 8–12 hours as needed) for the first 24–48 hours. Non-
steroidal antiinflammatory (NSAID) medication was either
carprofen (4 mg/kg subcutaneously) or meloxicam (0.2 mg/kg
subcutaneously) administered at induction of anesthesia, and
continued at 1–2 mg/kg orally every 12 hours (carprofen)
or 0.1 mg/kg orally once daily (meloxicam) for 14–48 days.
Selection of NSAID depended on any recorded responses or
adverse effects associated with previous NSAID administra-
tion and on owner preference for delivery method. Cage rest
and progressively increasing duration of leash-only walking
(to a maximum of 30 min/walk, 4 times daily) were enforced
until repeat arthroscopy.
Clinical, Radiographic and Arthroscopic Re-Examination
Clinical examination was performed at 2, 5–6, and 12–18
weeks and owners were requested to return for reassessment if
lameness persisted or recurred on any leg thereafter. Clinical
evaluation was performed in all dogs by 1 clinician (N.F.) and
included subjective evaluation of lameness of both donor and
recipient limbs, and presence of palpable effusion, crepitus or
pain on manipulation of both donor and recipient joints, as
conducted preoperatively. Radiography of both donor and
recipient joints was performed immediately postoperatively, at
12–18 weeks and at any subsequent reevaluations thereafter.
Radiographic projections were the same as those per-
formed preoperatively and were reviewed by 1 clinician
(R.Y.). Particular attention was paid to subchondral bone
contour and trabecular pattern at the graft site, and to areas of
likely osteophyte formation such as the caudoproximal aspect
of the anconeal process of the operated elbows or the distal
pole of the patella and cranial and caudal margins of the

FITZPATRICK, YEADON, AND SMITH
Fig 3. (A) Osteochondral core inserted into recipient socket. Instrument shown is OATSt Concave Tamp for positioning of core.
(B) Final appearance of 2 cores in situ used to maximally cover elliptical osteochondral defect. Note that second core overlaps
position of first core to optimize cover of osteochondral defect.
tibial plateau of donor stifles. Stifles were also evaluated for
radiographic indications of joint effusion such as cranial dis-
placement of the relatively radiolucent silhouette of the ret-
ropatellar fat pad, or caudal displacement of the fascial planes
in the region of the fabellae and caudal tibial plateau.
Repeat (2nd look) arthroscopy of the recipient site was
performed under general anesthesia at 12–18 weeks by 1 in-
vestigator (N.F.) following the same protocol as preopera-
tively, with particular attention to the graft site and
immediately contiguous cartilage, and the cut edge margin
of the MCP. Respective modified Outerbridge scores and de-
scriptive findings were recorded as for preoperative examin-
ation. Severity of synovitis (interpreted as any deviation from
the normal well-demarcated, pale pink, nonfimbriated, plica-
ted appearance of the synovium) was subjectively evaluated
and compared with video recordings of preoperative arthros-
copy (categorized as less severe, similar or more severe).
Statistical Analysis
Statistical analysis of available data was performed using
s
software (Minitab Release 14.20 software, Minitab Ltd.,
Coventry, UK). Descriptive statistics were calculated for sig-
nalment and preoperative clinical data. Variations in contin-
uous patient and preoperative clinical data (including body
weight, patient age, duration of preoperative lameness) were
compared between groups 1 and 2 dogs by Student’s t-test.
Associations between categorical outcomes data (including
clinical or arthroscopic outcomes assessed to be poor, and
increases in radiographic osteophytosis grade) and categorical
preoperative patient variables (including modified Outerbridge
scores for the medial humeral condyle and MCP, and presence
of gross fragmentation of the MCP) were investigated by
Fisher’s exact test. Associations between clinical, arthroscopic,
and radiographic outcomes measures, and continuous patient
or preoperative variables were assessed using Spearman’s rank
correlation coefficient (JMP version 6.0.0; SAS Institute, Cary
NC); confidence interval was set at 95%.
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251
RESULTS
Twenty–seven dogs (33 elbows) were included. Group
1 comprised 21 dogs (27 elbows) and group 2 comprised 6
dogs (6 elbows). Six of 27 dogs (all group 1) had single-
session bilateral procedures. Mean (  SD) age on ad-
mission was 7.7  1.61 months (median, 7 months; range
5–12 months). Mean body weight was 31.5  10.14 kg
(range, 19.5–66 kg). No significant difference (Student’s t-
test) was observed between groups 1 and 2 for mean age
on admission (T ¼ 0.13, P ¼ .897) or mean body weight
(T ¼ 0.88, P ¼ .394). There were 25 males and 2 females.
Only 2 male and 1 female dog had been neutered at time
of admission. Breeds were Labrador Retrievers (17),
Newfoundland (4), Golden Retrievers (2) and 4 other
breeds (1 each).
Historical and Preoperative Clinical Findings
Mean duration of preoperative lameness was 7.9 
4.95 weeks (median, 6 weeks; range 2–20 weeks) with no
significant difference detected between groups 1 and 2
(Student’s t-test; T ¼ 0.35, P ¼ .732). Severity of preop-
erative lameness determined by subjective assessment was
variable and ranged from mild and intermittent to severe
and persistent, weight-bearing lameness. Accurate grad-
ing of lameness was challenging in most dogs because of
the high incidence of bilateral thoracic limb lameness.
Subjective pain on elbow manipulation was reported for
all affected elbows and was most severe in full flexion and
on antebrachial supination during elbow flexion. Twelve
dogs had been prescribed NSAID before admission and 4
were being administered a nutraceutical containing glu-
cosamine and chondroitin sulfate. All dogs had exercise
restriction for  1 week preoperatively.

252 OSTEOCHONDRAL AUTOGRAFT TRANSFER
Preoperative Radiographic and Arthroscopic findings
Preoperative ordinal scores of radiographic
osteophytosis included grade 0 (n ¼ 1), grade 1 (21),
grade 2 (11) with no elbows scored as grade 3. On pre-
operative craniocaudal radiographic projections, all el-
bows had a ‘‘scalloped’’ subchondral bone defect of the
medial humeral condylar surface, which was confirmed
arthroscopically to be OCD. The cartilage flap was fully
separated in 27 of 33 elbows and partially separated in 6
elbows.
MCD was identified in 31 of 33 elbows (25/27 in group
1; all 6 in group 2) undergoing OAT procedures, based on
presence of radiographic changes including increased
ulnar radiopacity immediately caudal to the region of the
MCP described as ‘‘subtrochlear sclerosis’’13 and loss of
definition of the craniodistal edge margin of the coronoid
process on mediolateral radiograph projections and was
subsequently confirmed at arthroscopy. Arthroscopic pa-
thology identified included: (1) gross fragmentation with
adjacent cartilage pathology scoring modified Outer-
bridge grades 1 or 2 (n ¼ 10); (2) gross fragmentation with
adjacent cartilage pathology scoring modified Outer-
bridge grades 3 or 4 (n ¼ 10); (3) cartilage fissuring with
adjacent cartilage pathology scoring modified Outer-
bridge grades 3 or 4 (n ¼ 3); (4) cartilage pathology scor-
ing modified Outerbridge grades 3 or 4 without fissuring
or fragmentation (n ¼ 4); and (5) cartilage pathology
scoring modified Outerbridge grade 2 without fissuring or
fragmentation (n ¼ 3).
Treatment of MCD by SCO was performed in all 25
affected elbows in group 1 and in 5 of 6 affected elbows in
group 2. The affected elbow in group 2 not treated by
SCO was that of a 6-month-old Golden Retriever, and
arthroscopic pathology was focal modified Outerbridge
grade 2 cartilage pathology at the cranial edge margin of
the MCP.
Other concomitant orthopedic diseases identified clin-
ically, on survey radiography, or by arthroscopy were:
MCD of contralateral elbows (n ¼ 16); small (o5 mm
diameter) OCD lesions of the contralateral medial hu-
meral condyle, treated by cartilage flap removal and sub-
chondral bone debridement (n ¼ 3); radiographically
identified OC of the contralateral medial humeral con-
dyle without dissection of a cartilage flap, managed non-
surgically (n ¼ 2); stifle OCD (n ¼ 3; medial [1] and lateral
[2] condyle); hip laxity/dysplasia (n ¼ 2); ipsilateral shoul-
der (caudomedial humeral head) OCD (n ¼ 1); contra-
lateral antebrachial growth deformity featuring
caudolateral luxation of the radial head (n ¼ 1); and me-
dial patellar luxation (n ¼ 1).
Transfer of 2 cores was used to cover the osteochon-
dral defect in 13 of 33 elbows whereas a single core was
used in 20 elbows. Diameter of core articular surface was
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5.0 mm (n ¼ 2), 6.0 mm (16), 7.0 mm (23) or 8.0 mm (5).
Incomplete cover of the osteochondral defect by the
transplanted core(s) occurred in 6 elbows with estimated
percentage cover ranging from 70% to 95%. Mean core
depth was 8.3 mm (range, 7–12 mm).
Cores were harvested from the abaxial medial troch-
lear ridge (16 stifles, 26 cores), the PICT (6 stifles, 6
cores), or from both sites within the same joint (6 stifles,
14 cores). Only 1 core was harvested from the PICT re-
gion in any stifle. For unilateral elbow OAT procedures,
the ipsilateral stifle was used in 13 dogs and the contra-
lateral stifle in 8 dogs. In 1 dog with bilateral elbow OAT
procedures, both stifles were used as donor joints because
1 stifle was concomitantly treated by OAT for lateral
femoral condylar OCD and insufficient graft material
was available from that stifle for all 3 joints. In 2 other
stifles with concomitant medial (1) and lateral (1) femoral
condylar OCD, sufficient graft material was available
from the affected stifle to perform OAT procedures on
that stifle and a unilaterally OCD affected elbow.
Short Term Complications
The only major intraoperative complication was frac-
ture of 1 osteochondral core 4 mm below the osteochon-
dral junction during insertion. The core was inserted in 2
pieces without difficulty, and postinsertion stability was
considered adequate on direct palpation. Minor hemor-
rhage occurred from the donor core site in most dogs, but
was readily controlled by packing the site with a moist-
ened sterile gauze swab for 1–3 minutes before lavage and
closure. Hemostatic agents or bone wax were not re-
quired.
Short-term postoperative recipient joint complications
included suspected septic elbow arthritis (n ¼ 2) occurring
7 and 10 days postoperatively (neutrophilic effusion with
negative bacterial culture; both resolved within 4 days of
antibiotic administration), superficial wound infection 17
days postoperatively (1), and seroma at the ulna osteo-
tomy site present from 1 to 3 weeks postoperatively (1).
Short-term postoperative donor joint complications in-
cluded palpable stifle effusion and pelvic limb lameness
for 1–6 weeks postoperatively (n ¼ 5 including all 3 stifles
simultaneously operated for femoral condylar OCD),
skin sutures removed prematurely by the dog requiring
resuturing (1), and seroma (1).
Postoperative Clinical Outcome
Two dogs (2 elbows: 1 group 1, 1 group 2) were lost to
follow-up beyond 2 week postoperative reexamination.
Within 48 hours of surgery, all dogs were weight-bearing
on operated and donor limbs. Lameness resolved in 26 of
31 elbows in group 1 at 6.9  3.10 weeks (range, 3–13
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FITZPATRICK, YEADON, AND SMITH 253

Fig 4. Craniocaudal radiographs. Left elbow, 10-month-old Golden Retriever. Preoperative, immediate postoperative, and 6
week, 13 week, and 20 month postoperative appearance are shown. Note obliteration of scalloped subchondral defect postop-
eratively compared with preoperatively and position and obliquity of ulnar osteotomy.

weeks) and at 8.7  1.63 weeks (range, 6–10 weeks) for
group 2 dogs and in all dogs occurred in conjunction
with resolution of perceived discomfort on elbow manip-
ulation. Whereas we were unable to show a significant
difference in time to resolution of lameness
between groups, likely because of small case numbers,
lameness beyond the initial 2–3 week postoperative pe-
riod in group 2 was anecdotally considered attributable
to substantial and persistent discomfort at the ulnar
osteotomy site.
Lameness failed to resolve in 5 elbows within the fol-
low-up period and all were associated with poor out-
comes at repeat arthroscopy. These 5 dogs had persistent
discomfort evident on elbow manipulation, particularly
in full flexion and on supination in flexion.
Postoperative Radiography
Compared with preoperative radiographs, sub-
chondral contour was improved immediately after sur-
gery. Subchondral bone contour at the recipient site was
contiguous with the surrounding subchondral profile and
the preoperative ‘‘scalloped’’ subchondral defect was no
longer evident (Fig 4), a finding that was still apparent at
12–18 weeks. In 8 elbows, the subchondral bone contour
was noticeably elevated compared with the surrounding
medial humeral condyle despite accurate intraoperative
articular contour reconstruction, suggesting relatively
thin graft cartilage compared with cartilage thickness
surrounding the recipient site. At 12–18 weeks, there was
continuity of trabecular pattern and similar radiographic

Fig 5. Mediolateral radiographs. Left elbow, 10-month-old Golden Retriever (see Fig 4). Preoperative, immediate postoperative,
and 6 week, 13 week, and 20 month postoperative appearance are shown. Note progression of osteophytosis from grade 1
preoperatively to grade 2 by 6 weeks with minimal progression after 6 weeks.

254 OSTEOCHONDRAL AUTOGRAFT TRANSFER
Fig 6. Arthroscopic image at 13 weeks. Left elbow, 10-
month-old Golden Retriever (see Figs 4 and 5). Representative
of positive arthroscopic outcome after OAT and proximal ul-
nar osteotomy for medial humeral condylar OCD. Medial as-
pect of humeral condyle is on right. Osteochondral graft is
central within visible humeral condyle and extends beyond upper
limit of field of view. There is a visible cleft between cartilage
of graft and surrounding condyle with fibrils suggestive of
fibrocartilage infilling, but contour restoration is near-perfect
and surface appearance is consistent with hyaline cartilage.
OAT, osteochondral autograft transfer; OCD, osteochondritis
dissecans.
Fig 7. Arthroscopic image at 12 weeks after OAT. Nine-
month-old Labrador Retriever. There is inter zone scarring of
fibrocartilage between 2 contiguous osteochondral grafts in the
medial aspect of the humeral condyle which did not overlap to
cover the entire surface of the osteochondral defect. OAT,
osteochondral autograft transfer.
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Fig 8. Arthroscopic image at 12 weeks after OAT for medial
humeral condylar OCD with MCD, but without proximal ulnar
osteotomy. Ten-month-Labrador Retriever. Representative of a
negative arthroscopic outcome. Graft is top left of image—note
pale fibrillated surface and poor continuity of contour with re-
cipient humeral condylar surface. Both surrounding humeral
condylar articular surface (upper 60% of image) and distomedial
ulnar articular surface immediately caudal to coronoid region
(bottom right of image) have complete eburnation of cartilage
surface with exposure of subchondral bone. Axial linear grooves
are apparent within the eburnated surface consistent with per-
sistent frictional abrasion—‘‘humeroulnar conflict.’’ OAT,
osteochondral autograft transfer; OCD, osteochondritis disse-
cans; MCD, medial coronoid disease.
opacity at all recipient sites, consistent with bony incor-
poration of the graft.
In group 2 dogs, bony union of the ulna osteotomy
was evident by 12 weeks.
Ordinal grading of radiographic osteophytosis had in-
creased at 12–18 weeks in 9 of 31 elbows, each by 1 grade
(Fig 5), including the elbow previously scored as grade 0.
Scores were grade 1 (n ¼ 15), grade 2 (15), and grade 3
(1). Overall grade or increases in osteophytosis grade did
not associate with surgical group or with other patient
variables by Fisher’s exact test or Spearman’s correlation
coefficient.
Compared with immediate postoperative radiographs,
all donor sites had increased radiographic opacity at 12–
18 weeks consistent with cancellous bone infilling. There
was no radiographic evidence of periarticular osteophyto-
sis in any donor joint. Effusion, evident as opacification
encroachment of the infrapatellar fat pad silhouette, had
resolved by 12–18 weeks in all dogs including those si-
multaneously operated by OAT for femoral condylar
OCD.
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FITZPATRICK, YEADON, AND SMITH 255

Fig 9. Mediolateral radiographs. Left stifle. Ten-month-old Golden Retriever (see Figs 4–6). Immediate postoperative, 13 weeks
and 20 months postoperative (left to right respectively). Stifle was used as donor stifle for single osteochondral core (from PICT
region). Note lack of radiographic indicators of effusion or osteophytosis on follow-up images. PICT, plateau intersect of condyle
and trochlea.

Repeat Arthroscopy—Group 1
Twenty-six elbows (20 dogs) were reevaluated; 16 were
considered to have good arthroscopic outcomes, includ-
ing both elbows without recognized MCD. The grafted
cartilage surface was palpably resilient and well con-
formed to the articular contour. Cartilage cover of the
graft was complete with a gross appearance consistent
with healthy hyaline cartilage (Fig 6). The graft was well
demarcated by a small cleft between donor and recipient
cartilage, consistent with absence of cartilage integration.
For multiply grafted sites where there was incomplete
cover of the lesion, scarring of intercore zones with fi-
brous tissue in-fill was evident. This tissue had gross ap-
pearance consistent with fibrocartilage and mildly
distorted the articular surface (Fig 7). These interstices
were consistently, palpably softer than the surrounding
hyaline cartilage or the grafted cartilage. Synovitis was
subjectively absent or mild in all examined elbows. Where
SCO was performed, fibrous tissue ingrowth had oc-
curred at the ostectomy site to cover the previously ex-
posed subchondral bone.
Five elbows were considered to have intermediate ar-
throscopic outcomes. In these cases, partial thickness
(modified Outerbridge grades 2–3) erosion of cartilage
surrounding the graft was apparent, with linear tracts
suggestive of frictional abrasion from the apposing ulnar
articular surface. The graft had retained a palpably re-
sistant cap consistent with hyaline cartilage but in some
cases this appeared thinned or partially abraded, and the
graft ‘‘stood proud’’ from the surface of the remainder of
the humeral articular surface. Mild synovitis was present
but was subjectively improved when compared with pre-
operative arthroscopy video recordings of the same
joints. The SCO site had fibrous tissue ingrowth in all 5
elbows similar to that described earlier, although the
distomedial ulnar articular surface immediately proximal
to the ostectomy had some areas of abrasion or fibrilla-

Fig 10. Mediolateral radiographs. Nine-month-old Rottweiler. Immediate postoperative (left stifle only) and 13 months post-
operative (left and right stifles). Left stifle was used as OAT donor stifle (2 cores from abaxial medial trochlear ridge - visible on
immediate postoperative image). Note marked effusion and mild osteophytosis of both left and right stifles at 13 months, associated
with bilateral cranial cruciate ligament rupture. OAT, osteochondral autograft transfer.

256 OSTEOCHONDRAL AUTOGRAFT TRANSFER
Fig 11. Photograph taken during surgical management of
complete cranial cruciate ligament rupture of left stifle of 9-
month-old Rottweiler (see Fig 10) showing gross appearance of
one donor graft site (13 months after graft collection). Note
partial infilling of socket with fibrous tissue and presence of
mild peripheral vascularization.
tion similar to that observed on the opposing humeral
surface.
Five elbows were considered to have poor ar-
throscopic outcomes. All 5 affected thoracic limbs (3
dogs unilateral, 1 dog bilateral) had persistent, moderate
or severe, weight bearing lameness. Full thickness carti-
lage erosion was apparent throughout the medial joint
compartment including the distomedial ulnar articular
surface and the medial humeral condyle (Fig 8). The graft
region was severely eburnated, and in 2 elbows was not
identifiable. Moderate or severe synovitis was present and
subjectively similar or worse when compared with pre-
operative arthroscopy video recordings of the same
joints.
Incidence of intermediate or poor arthroscopic out-
comes was significantly associated with presence of mod-
ified Outerbridge grade 3 or greater cartilage lesions
affecting the major nonfragmented portion of the MCP
preoperatively (Fisher’s exact test, P ¼ .046), but was not
associated with presence of gross MCP fragmentation or
with any other patient variable.
Repeat Arthroscopy—Group 2
Five of 6 elbows were reexamined; all had good ar-
throscopic outcomes with excellent articular congruency
at the graft site, healthy, robust appearance of cartilage of
both the graft and surrounding condylar surface, and
complete or near-complete resolution of subjectively-as-
sessed synovitis.
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Long-Term Outcome
Clinical and radiographic evaluation at 12–28 months
(mean, 16.7  4.1 months) was available for 7 dogs (all
group 1; 9 of 33 recipient elbows, 8 of 28 donor stifles).
Reasons for repeat examination were cranial cruciate lig-
ament rupture of nondonor stifle (1), bilateral cranial
cruciate ligament rupture (1, including 1 donor stifle),
assessment or management of hip dysplasia (2), long-
term monitoring after contralateral antebrachial limb de-
formity management (1), management of traumatic meta-
tarsal fractures (1) and owner-requested evaluation (1).
In the single dog without additional recognized orthope-
dic disease, no lameness was apparent on subjective
assessment.
All elbows maintained subchondral bone contour with
no evidence of a ‘‘scalloped’’ defect at the previous OCD
site. Where a step had been identified between donor and
recipient subchondral contour immediately postopera-
tively on craniocaudal projections, it was no longer vis-
ible and there was apparent continuity of the subchondral
profile. Four of the 9 elbows had increased radiographic
osteophytosis scores (from grades 2–3) whereas scores in
the other 5 elbows were unchanged from their 12–18
week appearance (2 grade 1, 3 grade 2).
For 7 of 8 donor stifles, there was no radiographic
evidence of osteophytosis or effusion and the donor site
was not distinguishable (Fig 9). One stifle with concom-
itant cranial cruciate ligament rupture had mild radio-
graphic osteophyte formation associated with the distal
aspect of the patella, the proximal aspect of the femoral
trochlea, and the caudal and cranial extents of the tibial
plateau, and marked effusion, but did not differ markedly
from the contralateral stifle which was also affected by
cranial cruciate ligament rupture but had not been used
as an OAT donor site (Fig 10).
DISCUSSION
Clinical and arthroscopic outcomes in grafted elbows
with OCD and concomitant MCD but not treated with
proximal ulnar osteotomy were variable (14 of 24 were
considered good, 5 intermediate, and 5 poor). Clinical
and arthroscopic outcomes in grafted elbows with OCD
but without MCD and treated with proximal ulnar
osteotomy were considered good at 12–18 weeks. Radio-
graphic outcomes were consistent with reestablishment of
a normalized subchondral bone outline at the previous
defect, but osteophytosis continued to progress by at least
1 grade in 9 of 31 dogs by 12–18 weeks, and in 4 of 9 dogs
at 12–28 months.

FITZPATRICK, YEADON, AND SMITH
Limitations
We acknowledge some important limitations with this
study. The outcomes measures used were almost exclu-
sively subjective. Lameness evaluations were particularly
challenging because of the high incidence of bilateral
thoracic limb orthopedic disease and concomitant pelvic
limb disease. Donor collection from a pelvic limb joint
also complicated lameness evaluation postoperatively.
Furthermore, all postoperative clinical and arthroscopic
evaluations were performed by the primary surgeon
(N.F.) who was aware of previous clinical data, so some
bias affecting subjective assessments was unavoidable.
The lack of objective histologic or biomechanical data to
support perceptions of donor core outcomes within this
study is a further limitation, particularly in the absence
of experimental data to support viability in the canine
elbow.
Direct comparison of outcomes cannot be made with
other studies because of inconsistent reporting of various
diseases encompassed by ‘‘elbow dysplasia’’ in the exist-
ing literature, the high incidence of concomitant MCD in
our dogs, the limited number of dogs within each surgical
group, and the limitations acknowledged earlier.
Surgical Technique
Clinical application of OAT was considered techni-
cally straightforward. Because of the typical, relatively
abaxial location of medial humeral condyle OCD lesions,
perpendicular access to the OCD lesion for instrumenta-
tion was readily achieved by medial arthrotomy and use
of a fulcrum placed lateral to the elbow joint, without
impairing integrity of the medial collateral ligament. Le-
sion access was more than adequate but SCO when per-
formed further enhanced access. Accurate, durable
reconstruction of the articular surface with hyaline car-
tilage was achieved intraoperatively in all elbows.
Our decision to drill the recipient socket before col-
lection of donor osteochondral cores is potentially con-
tentious, but is an approach used in people.24,26 It is
based on the rationale that appropriate selection of
osteochondral core length (and perhaps width and con-
tour) may be tailored on an individual basis depending on
the degree of subchondral bone pathology (e.g. sclerosis,
cyst formation, or severe bone edema) as subjectively de-
termined during drilling and direct observation of the
articular contour. The major potential complication us-
ing this approach is the possibility for inadvertently har-
vesting a donor core of insufficient length to fill the
recipient socket. To minimize this risk, we routinely col-
lected donor cores 2–3 mm longer than required.
Our experience both within these dogs and in a con-
temporaneous study using stifle-to-stifle OAT proce-
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257
dures18 is that the degree of ‘‘grip’’ between the
OATSt core harvester trephine and canine subchondral
bone is variable and commonly results in collection of
cores 1–2 mm shorter than intended because the base of
the core fractures within the trephine rather than flush
with the cutting surface. Consequently, collection of
slightly longer cores than required and subsequent trim-
ming may be a sensible precaution for canine OAT
procedures. Although we had no intraoperative compli-
cations attributable to this sequence, use of the more
‘‘conventional’’ approach described by Cook et al17 is
worthy of consideration dependent on surgeon experience
and preference. However, for stifle-to-elbow grafting,
topographical mapping of highly contoured recipient
sites may be facilitated by the approach we used because
an appropriate donor location can be identified for the
already created recipient site.
We used a core depth of 7–12 mm that subjectively
based on available bone stock and the depth required to
achieve graft stability after implantation. In all elbows,
this core depth was adequate to expose visually normal,
bleeding subchondral bone. Socket depth recommended
for human knee lesions is 13–15 mm for cartilage tears
and 20–25 mm for OCD,38,39 although this may vary ac-
cording to the depth of the subchondral lesion and be-
tween surgeons. Subchondral edema and sclerosis
associated with osteochondral lesions could theoretically
delay revascularization of the transplanted core; however,
subchondral edema may be limited to the acute phase of
osteochondral injury40 and subchondral sclerosis at the
OCD site was not observed as a major radiographic fea-
ture in any of our dogs. No firm recommendations can be
made about graft core depth in dogs, but the dimensions
we used were not associated with overt loss of fixation or
loss of cartilage viability even with 2 contiguous grafts.
Incomplete coverage of the lesion occurred in 6
elbows. Although likely suboptimal and potentially
contributing to uneven load distribution at the graft site,
this scenario is presumably preferable to absence of a
graft. In an sheep model, use of a 6 mm plug in the center
of a 10 mm defect yielded superior results (visually, ra-
diographically, and histologically) at 6 and 12 months
compared with leaving the lesion empty or filling it with
autogenous cancellous bone graft.41 This may be clini-
cally relevant where a lesion is only partially accessible by
standard surgical approaches, where the lesion is shaped
such that 2 divergent cores provide potentially better
topographical contour, or where donor graft material
is limited.
Outcomes
Outcomes for group 1 were considered sufficiently in-
consistent to support a recommendation for clinical use.

258 OSTEOCHONDRAL AUTOGRAFT TRANSFER
This outcome was attributed to the incidence of progres-
sion of abrasion of cartilage across the medial humeral
condyle after treatment of concomitant disease of the
MCP and medial humeral condylar OCD, which to our
knowledge has not been reported perhaps because repeat
arthroscopy has not been an outcome measure in previ-
ous reports of canine elbow disease. We do not consider
this phenomenon of progressive cartilage abrasion di-
rectly associated with the OAT procedure, but more
likely with a syndrome of ‘‘humeroulnar conflict’’42 that
may comprise a dynamic or difficult-to-detect static in-
congruency between the humerus, radius, and ulna re-
sulting in abnormal or excessive loading of the
humeroulnar contact surface. This hypothesis is sup-
ported by the relatively positive subjective outcomes doc-
umented in elbows not affected by MCD and by cases
where ulnar osteotomy was performed and thus, warrants
further investigation. The high incidence of OCD asso-
ciated with MCD and ‘‘humeroulnar conflict’’ in our
dogs may support the previously suggested hypothesis
that the etiopathogenesis of OCD may include abnor-
mally increased load bearing, although this should not
detract from studies investigating multifactorial origins.
Inclusion of ulnar osteotomy (group 2) occurred be-
cause of the high incidence and nature of suboptimal
outcomes observed in group 1 dogs. Abrasion of the
medial humeral cartilage was associated with preopera-
tive cartilage pathology (modified Outerbridge grades 3
or 4) across most of the MCP excluding areas of fissuring
or fragmentation. When used as a predictive indicator for
suboptimal outcome, this measure of coronoid pathology
had a sensitivity of 55% and a specificity of 92%. We
therefore suggest that in the absence of a more reliable
predictive test for humeroulnar conflict, ulnar osteotomy
may warrant consideration as a prophylactic procedure
when OAT is performed in a joint concomitantly affected
by MCD. This can be justified by the relatively low mor-
bidity we observed associated with ulnar osteotomy
(lameness resolved by 12 weeks) compared with the se-
vere implications of progressive medial compartment
cartilage eburnation.
We observed postoperative variation in cartilage thick-
ness between donor and recipient sites as a radiograph-
ically visible step in subchondral bone. Differences in
cartilage thickness may be compensated by microscopic
cartilage remodeling43,44; however, the associated biome-
chanical changes may result in uneven wear of these areas
over time. Adequate long-term follow-up is not available
for human or canine patients to appreciate the clinical
importance of this variation in cartilage thickness. Vari-
ation in graft core orientation and the effects of mis-
matching between minimally and maximally weight-
bearing areas are incompletely understood. There has
been suggestion that split-line pattern divergence or mis-
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matching in human patients may accelerate articular de-
generation,45 although this not been documented as
influencing core survival or clinical outcome. Accord-
ingly, accurate anatomic matching between donor and
recipient sites must be recommended to maintain artic-
ular congruency, and further investigation to match op-
timal donor sites for common lesion locations is
warranted. However, early work with filler hydrogels
for osteochondral lesions suggests that mechanical sup-
port and biological inertia may be sufficient attributes for
replacement cores and that surface morphology of the
graft may be less important, provided it facilitates dim-
inution of articular inflammation.46
Donor Morbidity
Donor site morbidity was limited. Two stifles had ex-
tra-articular complications associated with the surgical
wound (seroma and premature suture removal) and 5
stifles had overt lameness and effusion within the first 6
weeks; however, 3 of these also had simultaneous surgery
for femoral condylar OCD so some postoperative lame-
ness would be expected.17 No other donor joint morbidity
was identified and all stifles appeared clinically and ra-
diographically quiescent at 12–18 week evaluation. One
donor stifle had a cranial cruciate ligament rupture di-
agnosed 13 months after the OAT procedure. This Rot-
tweiler was admitted with simultaneous bilateral cranial
cruciate ligament rupture, and radiographic evidence of
effusion and osteophytosis were indistinguishable be-
tween donor and nonoperated stifles. Whereas accelera-
tion or initiation of degenerative cruciate ligament disease
by the OAT harvesting procedure (e.g. by initiating an
inflammatory cascade) cannot be excluded, signalment
and concomitant contralateral disease suggests that it was
unlikely a major factor influencing stifle pathology in
this dog. Furthermore, examination of the previous do-
nor site during surgical intervention for cranial cruciate
ligament insufficiency revealed substantial fibrous infill-
ing (Fig 11), albeit with a residual defect in the articular
surface, and only minimal peripheral vascularization
or evidence of inflammation. Further monitoring to
establish incidence and severity of anticipated donor site
morbidity in canine patients is needed.
Optimal postoperative care remains an unresolved
paradox within human osteochondral transplantation.
Early motion is critical for nutrition of transplanted car-
tilage so immobilization is not recommended.47 However,
concerns have been raised about core subsidence or
collapse, or excessive focal contact pressures during the
period before cartilage adaptation or osteointegration.
Typical rehabilitation in human patients includes passive
range of movement physiotherapy from 1 day postoper-

FITZPATRICK, YEADON, AND SMITH
atively, with gradual increase to full weight-bearing at
5–8 weeks. Little quantitative data is available about
optimization of postoperative rehabilitation in humans. 11.
Our current recommendations for dogs are based on
cautious adaptation of typical protocols for human pa-
tients and are further challenged by patient compliance.
OAT procedures for medial humeral condylar OCD 12.
lesions in the dog are technically feasible and permit ac-
curate short-term reconstruction of articular contour by
13.
resurfacing with hyaline like cartilage. Ancillary proximal
ulnar osteotomy may be beneficial when there is con-
comitant MCD, because it may protect the graft site from 14.
potential frictional abrasion, which putatively may be a
manifestation of incongruity. Long-term outcomes are 15.
unknown, but viability and limited morbidity established
in our dogs prompts further investigation of OAT pro- 16.
cedures as a potential approach for management of nat-
urally-occurring OCD of the canine medial humeral
condyle. 17.
18.
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