Background: Osteochondritis dissecans (OCD) of the capitellum is a common cause of pain and dysfunction in adolescents that engage in repetitive elbow loading. For large, unstable lesions fresh osteochondral allograft transplantation (FOCAT) from the femoral condyle has been described as an effective treatment. Current practice involves significant guesswork in obtaining an appropriately sized graft, with anatomic variations resulting in poor graft fit. No studies currently exist that analyze and identify the best distal femur FOCAT graft site to repair OCD lesions of the capitellum based on the radius of curvature (ROC) and simulated matching. Methods: Computed tomography scans of the elbow were used to estimate the subchondral bone ROC of capitella in adolescents aged 11 to 21 years. The capitellar location used corresponds to the most commonly reported site of OCD lesions in the elbow. Computed tomography scans of the lower extremity were used to estimate the subchondral bone ROC of 4 potential donor femoral condyle grafts. ROC from distinct regions at the posterior section of both the medial and lateral femoral condyles were measured: 2 areas representing 10 mm grafts from the center (MC1 and LC1), and 2 areas estimating 10 mm grafts posterior and adjacent to the physeal scar (MC2 and LC2). Intraobserver and interobserver reliability measurements were preformed to corroborate precision and validate the method. Results: The mean ROC of healthy subchondral bone at the region of the capitellum were OCD lesions most commonly occur was 9.79 ± 1.39 mm. The mean ROC of MC1 was 18.61 ± 2.26 mm. The average ROC of the MC2 was 15.23 ± 1.43 mm. The average ROC of LC1 was 16.47 ± 1.34 mm. The average ROC of LC2 was 18.19 ± 3.09 mm. After 15,000 simulated condyle-tocapitellar site matchings based on these measurements, a good fit graft was achieved at a frequency of 15%. Discussion: No site measured from the femoral condyle demonstrated a subchondral ROC that exactly matched the subchondral ROC of the capitellum at the center location where OCD lesions most commonly occur; of the locations measured, a 10 mm section from MC2 demonstrated the closest match. On the basis of this analysis, extracting a graft from MC2 has the potential to further optimize FOCAT fit to the capitellum. Level of Evidence: Level III.

Osteocondritis dissecans (OCD) is a focal change in subchondral bone thought to be caused by factors that include genetic, vascular, microtrauma, or a combination of these. OCD lesions can be treated with nonoperative or operative management depending on severity. For larger, unstable lesions, fresh osteochondral allograft transplantation (FOCAT) has been described as an effective treatment. Fresh allografts are harvested from cadaver tissue and are applied operatively to the lesion. Despite generalized donor sites providing a good match to recreate the native joint anatomy, specific donor anatomy may result in poor graft fit. Restoring natural curvature is critical for successful treatment of OCD symptoms using FOCAT, and currently significant guess work is used to determine the graft tissue extraction site from the femoral condyle. In this study, goodness of fit of osteochondral allografts transplants is tested by measuring and analyzing radius of curvature (ROC) using a picture archiving and communication system (IMPAX, Agfa Healthcare, Mortsel, BE). The protocol for measuring ROC of the capitellum is adapted from data outlining the average size and location of OCD lesions on the capitellum. The protocol used for determining the ROC of potential graft extraction sites from the femoral condyle is based on early measurement data collected in this study. Upper extremity and lower extremity CT scans of OHSU patients with no evidence of prior surgery, intra-articular damage, variation of normal anatomy, or degenerative joint disease were used in this study.

The Bridges Collaborative Care Clinic (BCCC) is Oregon’s first and only interdisciplinary, student-run clinic that provides free health and social services to underserved populations. The hierarchical leadership structure utilized by the clinic since its inception in 2016 worked effectively in the early stages of development. As the clinic matured, increasing complexity of programs and administrative duties led to lapses in communication and loss of information between teams, resulting in decreased efficiency and impact as measured by clinical output. Student volunteers and the BCCC Board of Directors recognized the need for organizational change and proposed developing a strategic plan. This paper describes the process, outcomes, and limitations faced by BCCC throughout its strategic planning. The Quality Function Deployment (QFD) model was implemented because of its collaborative approach of involving the customers—people who receive the services—in order to shape future initiatives for the organization. In this case, the QFD defines the customers as the participants who are seeking care at the clinic. The outcomes of the strategic planning process are expected to help the clinic function more efficiently and include a prioritized list of participant-defined needs, a list of solutions, and a timeline to guide new projects. By illustrating the implementation of QFD and its potential complications, other student-run clinics that are seeking improvement can replicate or adapt this method to develop their own strategic planning processes.