Radial Head Excision and Achilles Allograft Interposition Arthroplasty for the Treatment of Chronic Pediatric Radiocapitellar Pathologies- A Report of 4 Cases

Background: The quest for the best suitable treatment for pathologies of the radiocapitellar joint is ongoing. In the pediatric population, radial head arthroplasty or resection alone might be problematic due to possible radiocapitellar wear and proximal migration of the radius. We present a case-series of 4 patients treated with radial head excision followed by Achilles Allograft interposition arthroplasty (AAIA) for the treatment of lateral elbow pain and limitation in elbow motion related to radiocapitellar pathologies.

Methods: 4 pediatric patients with a mean age of 13 years, who were treated with AAIA following resection of the radial head, were assessed for their clinical and radiographic outcome using the VAS, MEPS and DASH scores as well as measurements of their grip strength and range of motion (ROM).

Results: Clinical and radiographic evaluation was performed at a mean follow-up of 16 months.

At the final follow up, the average VAS, MEPS and DASH scores were 2, 92.5 and 11.5 accordingly.

The average Flexion- Extension elbow ROM arc improved from 12-119 preoperatively to 5-136, rotation arc improved from 50-57 preoperatively to 62-84.

One patient demonstrated slow post-operative gain of elbow motion, and hence he underwent a manipulation under general anesthesia (MUA) 6 weeks following the surgery. Another patient underwent ulnar shortening osteotomy 12 months following the surgery due to increasing wrist pain that was related to proximal migration of the radius. Two patients showed significant relief from their preoperative pain and mechanical symptoms, with return to unrestricted activities.

Conclusion: Radial head excision and AAIA represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with moderate to good results in terms of clinical and functional outcome as well as patient satisfaction. Further studies with long-term follow up should be conducted in order to further assess the outcome, function and possible complications of this promising procedure.