Osteochondritis dissecans of the elbow

Osteochondritis dissecans of the elbow is a localized condition of the articular surface that is commonly seen in the young athlete. This disorder refers primarily to lesions of the capitellum and can be difficult to treat. Although trauma and ischemia play significant roles, the exact etiology remains unknown. The natural history is poorly understood and long-term sequelae include degenerative arthritis. The integrity of the articular surface and the stability of the lesion can be carefully evaluated with MRI and arthroscopy. Management is based mainly upon these two factors, yet no good universal outcomes exist among the varied treatment options. Stable lesions identified early appear to have the best prognosis with conservative management. Indications for surgery include persistent or worsening symptoms despite prolonged conservative care, loose bodies, or evidence of instability. Whether to excise and débride or to fix an unstable fragment is a highly controversial topic. The clinician should recognize osteochondritis dissecans of the elbow as a potentially disabling condition where the prognosis for return to sport is guarded.