Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone leading to the loss of support to the articular cartilage. This condition affects adolescents, especially those in overhead-throwing sports and activities that require weight bearing on the elbow. Patients often exhibit lateral elbow pain, aching at rest, and restricted elbow motion. Radiographs and magnetic resonance imaging should be used for diagnosis and staging of OCD. OCD lesions can be classified into 4 stages; stages I and II are considered stable lesions whereas stages III and IV are unstable lesions. Stable lesions can be treated conservatively by stopping the aggravating activity with 3-6 weeks of immobilization. Physical therapy and gradual return to play follow the period of rest. For unstable, advanced lesions in patients who have failed nonoperative treatment, surgery is the most effective treatment. Multiple surgical options are available including open debridement, arthroscopic debridement, microfracture, fragment fixation, and osteochondral mosaicplasty.