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 with no functional deficits 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 login to view 1 more bullet catching / locking / grinding login to view 1 more bullet 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 login to view 1 more bullet technique login to view 1 more bullet outcomes login to view 1 more bullet Operative arthroscopic debridement and loose body excision indications login to view 2 more bullets post op care login to view 3 more bullets arthroscopic microfracture or drilling of capitellum indications (separated fragments) login to view 2 more bullets technique login to view 2 more bullets post op care login to view 3 more bullets outcomes login to view 1 more bullet fixation of lesion indications login to view 1 more bullet technique login to view 1 more bullet post op care login to view 3 more bullets outcomes login to view 1 more bullet osteochondral defect reconstruction (autograft or allograft transplantation surgery (OATS)) indications login to view 2 more bullets post op care login to view 3 more bullets 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