Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans (OCD) of the elbow is an increasingly recognized cause of elbow pain and dysfunction in adolescent athletes. This is particularly common in gymnasts and throwing athletes, and it may curtail an athlete’s career and lead to subsequent degenerative arthritis. Patients present with elbow pain and stiffness and may have mechanical symptoms. The capitellum is most commonly affected, and typical radiographic findings may be seen on x-rays or magnetic resonance imaging. Nonoperative management is successful for most patients with stable lesions. Operative intervention is indicated for patients with unstable osteochondral defects. Various operative techniques have been described, including fragment excision with or without marrow stimulation, fragment fixation, osteochondral autograft transfer, and distal humeral osteotomy. Arthroscopy has become increasingly utilized for the diagnosis and management of elbow OCD. Although elbow arthroscopy is technically demanding, it allows complete evaluation of the elbow joint and treatment of concomitant elbow pathology via a minimally invasive approach. After review of alternative operative interventions, we describe our preferred technique of arthroscopic debridement and drilling for capitellar OCD.