summary Osteochondritis Dissecans of Elbow is a localized injury and subsequent separation of articular cartilage and subchondral bone of the capitellum, most commonly seen in gymnasts and pitchers. Diagnosis can be made with plane radiographs but MRI studies can be helpful to evaluate for the size of lesion and extent of bony edema. Treatment can be nonoperative or operative depending on size of the lesion, stability of the lesion, and presence of loose bodies. Epidemiology Demographics usually occurs after age 10 (typically adolescents) juvenille OCD better prognosis than adult boys more common than girls Anatomic location typically located in capitellum of dominant upper extremity Risk factors repetitive overhead and upper extremity weight bearing activities gymnasts and throwing Etiology Pathophysiology theorized to result from repetitive compression-type injury (overhead or upper extremity weight bearing activities) of the immature capitellum causing vascular insufficiency repetitive microtrauma Associated conditions Panner's disease (osteochondrosis of the capitellum) typically presents in first decade of life (<10 years old) usually benign self-limiting course same mechanism of injury as OCD surgery is contraindicated for Panner disease (unlike OCD elbow) Anatomy Capitellum is supplied by 2 end arteries radial recurrent artery interosseous recurrent artery Classification Radiographic and Arthroscopic Classification Type I Intact cartilage Bony stability may or may not be present Type II Cartilage fracture with bony collapse or displacement Type III Loose bodies present in joint Presentation Symptoms elbow pain insidious, activity-related onset of lateral elbow pain in dominant arm mechanical symptoms loss of extension early sign catching / locking / grinding late signs if loose bodies present Physical exam lateral elbow tenderness mild loss of extension possible effusion of elbow joint usually mild may or may not present with crepitus Imaging Radiographs recommended views AP and lateral of the elbow findings plain radiographs can confirm the diagnosis based on bone defect capitellum is most commonly involved Panner disease exhibits an irregular epiphysis, OCD a well-defined subchondral lesion MRI most useful for assessing: size extent of edema cartilage status Treatment Nonoperative cessation of activity +/- immobilization indications type I lesions (stable fragments) technique 3-6 weeks followed by slow progression back to activities over next 6-12 weeks outcomes >90% success rate Operative arthroscopic microfracture or drilling of capitellum indications (separated fragments) unstable type I lesions stable type II lesions technique microfracture of chondral lesion extra- or transarticular drilling of defects post op care protected early range of motion strengthening at 2 months throwing and weight bearing at 4-6 months outcomes good success rate fixation of lesion indications large lesions that are incompletely displaced technique arthroscopic reduction and fixation post op care protected early range of motion strengthening at 2 months throwing and weight bearing at 4-6 months outcomes highly variable arthroscopic debridement and loose body excision indications unstable type II lesion type III lesions post op care early range of motion +/- brace begin strengthening when range of motion is painfree no throwing or weight bearing activities X 3 months osteochondral autograft or allograft transplantation surgery (OATS) indications large type II and III capitellar lesions which engage the radial head uncontained lesions may require size-matched fresh allograft post op care early range of motion resistive/strengthening exercises at 3 months progressive throwing program begins at 5 months through 7 months Complications Elbow stiffness Pain Unable to return to sports Arthritis Prognosis Prognosis based on physeal status Most heal between 6 to 18 months of nonoperative treatment Wide range of potential disability inability to participate in sports at same level up to 50% develop arthritic changes long term