Osteochondritis Dissecans of the Capitellum: Arthroscopic Microfracture

Osteochondritis dissecans of the capitellum is a focal injury to the articular cartilage and subchondral bone observed in young athletes. This can cause activity-limiting pain, intra-articular loose bodies, and limited range of motion.

Stable lesions identified early with minimal symptoms can be managed nonoperatively. Indications for surgical management include unstable lesions, loose bodies, mechanical symptoms, and stable lesions that failed 6 months of nonoperative treatment. A range of surgical options have been advocated-including arthroscopic versus open loose body removal, fracture fixation, drilling, microfracture, osteotomy, osteochondral autograft or allograft transplantation. Arthroscopic microfracture offers a minimally invasive approach.

After diagnostic elbow arthroscopy, the capitellar lesion is identified and inspected. Unstable cartilage is debrided, and the bony bed is prepared. A 1.1-mm (0.045") K-wire is then used along with a blunt-tipped 2.4 mm anterior cruciate ligament guide pin sleeve to perforate the subchondral bone spaced 2 mm apart throughout the base of the lesion.

Arthroscopic microfracture can relieve the patient's pain, improve motion, remove loose bodies, and initiate fibrocartilaginous filling of the defect.

Arthroscopic microfracture for osteochondritis dissecans of the capitellum offers a minimally invasive approach with good to excellent outcomes.

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