Osteochondritis Dissecans of the Capitellum: Management in the Throwing Athlete

Young overhead athletes, such as baseball players and gymnasts, are at risk of developing osteochondritis dissecans lesions of the capitellum. Repetitive microtrauma in conjunction with limited local blood supply likely contribute to the development of these lesions. Adolescent and young adult throwing athletes presenting with lateral-sided elbow pain and stiffness should undergo prompt evaluation and imaging with elbow radiographs. Advanced imaging with computed tomography and magnetic resonance imaging or arthrography can further diagnose these lesions and determine lesion size and stability. Skeletally immature individuals with early, stable lesions should be given a trial of conservative treatment. Lesions failing nonoperative management and unstable lesions may be treated operatively with arthroscopic debridement and microfracture, fragment fixation, or osteochondral autograft transplantation surgery depending on lesion stability, size, and location. A wide variety of surgical techniques and outcomes have been reported. Overall these techniques result in excellent outcomes with good return to sport rates, diminished pain, and improved range of motion.