Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans of the elbow is a disorder noted in young, repetitive-motion athletes. Although often characterized by inflammation, pain, and loss of motion, the pathological changes within the bone involve no inflammatory cells. Nonoperative management includes elimination of the secondary inflammatory changes, by rest and the use of anti-inflammatory modalities, combined with elimination of the stress to the capitellum by rest and the use of an off-loading hinged elbow brace. Nonoperative management is most effective when the cartilage cap overlying the lesion is intact. Surgical intervention may take several forms when the disorder either does not respond to nonoperative management or is discovered in a later stage. Percutaneous fixation of nondisplaced lesions, when there is enough bone in the loose fragment to allow purchase of the fixation device, is an attractive option. Arthroscopic removal of loose bodies, excision of an inflamed posterolateral plica, and microfracture of the residual defect may be of benefit in the intermediate stages. Patients in which these options fail, or in which there is extensive destruction of the bone and involvement of the extreme lateral cortex or “shoulder” of the capitellum, osteochondral grafting may be indicated. Results of each treatment modality are quite good, with success rates reported between 66% and 95%. The primary complications include loss of motion, early arthritis, and a failure to return to the same level of competition.