Aseptic necrosis of the capitulum of the humerus (Panner's disease) treated by solid chondrograft implantation

The authors present the case of aseptic necrosis of the humeral capitulum in a top female gymnast. She was referred to our department with the diagnosis of aseptic necrosis already made and after repeated arthroscopic treatment of the elbow including removal of a loose body in another institution. Exercise-related pain and swelling of the elbow became permanent and did not allow her to pursue her sports activities. After thorough examination, the treatment by implantation of autologous cultured chondrocytes, as a solid chondrograft, was chosen. At the first stage of arthroscopic surgery, a loose body was removed and a sample of healthy cartilage from an articular region not subject to strain was collected. The sample was sent to the Tissue Bank for cultivation and chondrocyte formation into a solid chondrograft, a procedure taking 4 to 5 weeks. At the second stage, the chondrograft was implanted into the lesion site and fixed with tissue glue (Tissucol). The arm was immobilised in a plaster cast for 4 weeks. The patient was followed up clinically and examined with magnetic resonance imaging at 6 month after implantation. The examination showed full graft integration and the arm's return to full mobility without pain at exercise. Even with this rare lesion site within the elbow joint, the implantation of a solid chondrograft proved to be a method achieving very good outcomes.