Arthroscopic and Open Surgery for Osteochondritis Dissecans

Osteochondritis dissecans lesions of the elbow occur in 3.4% of adolescent baseball players, and the lesions will inevitably progress without intervention. Fifty percentage of patients who initially presented with advanced lesions had decreased range of motion and pain with activities of daily living. Patients treated early have high return to sports rates. After radiographs are obtained, patients suspected of having an osteochondritis dissecans lesion in the elbow should undergo a magnetic resonance arthrogram to determine the integrity of the cartilage cap. Central lesions with an intact cartilage cap can often be successfully treated with bracing and a course of formal therapy. Patients who fail conservative treatment with a violated cartilage cap can undergo microfracture or fragment fixation. Patients with lesions that extend to the lateral wall require an autograft transfer to restore the structural integrity of the capitellum and prevent instability.