Dic 10

Managing Osteochondritis Dissicans of the Capitellum

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http://icjr.net/article_105_elbow_rgr#.VIhXmTGG-An

Managing Osteochondritis Dissicans of the Capitellum

A young gymnast presents with a history of recurrent elbow pain, swelling, and locking and catching. She has failed conservative treatment. When an unstable OCD lesion of the capitellum is diagnosed, the authors recommend elbow arthroscopy, removal of a loose body, and microfracture of the OCD lesion.

By Edward Chang – December 8, 2014

Authors
Edward S. Chang, MD, and Christopher C. Dodson, MD
Disclosures
The authors have no disclosures relevant to this article.
Background
Osteochondritis dissecans (OCD) of the capitellum is a rare disorder generally seen in the immature athlete. The exact etiology is unclear, however there is an association between this condition and athletes that sustain repetitive trauma to the radiocapitellar joint (ie, overhead athletes, gymnasts).
The typical presentation is in a young athlete with lateral elbow pain and swelling that is worse with activity and improves with rest. A detailed history and physical examination, along with advanced imaging modalities, can lead to early diagnosis.
Treatment of OCD lesions depends on the size, grade, and location:
  • Stable, low-grade lesions can be treated with rest and activity modification, with gradual return to sports.
  • Operative treatment is generally indicated for:
    • Unstable lesions
    • Presence of loose bodies
    • Mechanical symptoms
    • Failure of non-operative treatment
Surgical techniques range from debridement to fragment fixation to osteochondral autograft transplantation surgery (OATS). Clinical outcomes and return to sport vary by surgical technique, and long-term results are still needed to assess its efficacy.

The following case illustrates a classic presentation of a young gymnast with OCD of the capitellum who underwent successful treatment via arthroscopic repair.