Osteochondritis Dissecans of the Capitellum in the Young Athlete

Osteochondritis dissecans of the capitellum is an uncommon but notable cause of elbow pain in the young athlete. Although the exact pathogenesis of this condition is not completely understood, repetitive microtrauma, such as in throwing athletes or gymnasts, can predispose these groups to developing osteochondral lesions. Patients may present with laterally based elbow pain, swelling, or loss of range of motion. Initial screening radiographs can often detect these lesions, with MRI key to determining the exact lesion size, location, and stability. Treatment depends on multiple factors and may include a period of rest, particularly in stable lesions. Surgery is more often recommended in patients with unstable lesions or loose bodies or those who have persistent lesions despite a course of nonsurgical management. Historically, isolated osteochondritis dissecans removal and débridement yielded suboptimal results in the medium to long term, especially in larger and more laterally based lesions. Osteochondral autograft or allograft transplantation allows for more anatomic restoration of capitellar anatomy and has become the preferred treatment for larger, unstable defects with promising outcomes and return to activity.