Subtotal coronoid ostectomy (SCO) is a surgical treatment option for medial coronoid disease (MCD). The objective is to remove portions of the coronoid that are visibly diseased as determined by arthroscopic or CT scan interrogation and an additionalportion which may have suboptimal subchondral architecture on physical palpation or direct observation. There is a significant body of evidence, based on analysis of diseased coronoid samples by histology, histomorphometry and micro-CT that subchondral pathology exists both within visibly diseased regions of the medial coronoid process and in adjacent areas. This pathology has been attributed to fatigue microdamage with a mechanical overload aetiopathogenesis, though intrinsic biologic defects of the cartilage and subchondral bone have not been definitively precluded. Current evidence intimates that the physical response of the cartilage and bone of the medial coronoid process to disparate patterns of mechanical overload may explain observed cartilageand bone pathology, even in the absence of a definitive biologic defect. Microcracking of subchondral bone precedes gross fibrillation, Assuring and fragmentation of articular cartilage. Furthermore, in some clinical cases of MCD, fragmentation per se isnot observed but rather a general erosion and eburnation of the surfaces of the medial coronoid process and the medial aspect of the humeral condyle in a mirror-image striatory fashion, ascribed the term "kissing lesions" and mechanically attributable to humero-ulnar conflict (HUC).
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