Elbow arthroscopy: capitellar osteochondritis dissecans and radiocapitellar plica

The combination of excessive radiocapitellar compressive forces and the limited vascularity of the capitellum are responsible for the development of osteochondritis dissecans. Repetitive compressive forces are generated by throwing or racket swinging motions or from constant axial compressive loads on the elbow, which are common in athletes such as gymnasts. Symptoms include activity-associated pain and stiffness. Physical examination findings show tenderness over the radiocapitellar joint and, commonly, loss of extension. Plain radiographs may show flattening and sclerosis of the capitellum, lucencies, and possibly intra-articular loose bodies. MRI can detect bone edema early in the disease process and further delineate the extent of the injury. The management of osteochondritis dissecans lesions is primarily based on the demands of the patient, the size and location of the lesion, and the status and stability of the overlying cartilage. Possible treatments include transarticular drilling; removing detached fragments or loose bodies, followed by drilling; and mosaicplasty. Radiocapitellar plica can cause chondromalacic changes on the radial head and capitellum, with symptoms including painful clicking and effusions. Arthroscopic plica resection is indicated when nonsurgical treatment fails.