JAAOS - 2026-06-01 - Journal Article; Review
Osteochondritis Dissecans of the Capitellum in the Young Athlete.
Tramer JS, Haley RM, Saluan PM
Topics
Key Takeaway
Osteochondral autograft or allograft transplantation yields superior outcomes over débridement alone for capitellar OCD lesions >1 cm² or laterally based defects in young athletes.
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Summary
This narrative review examines diagnosis and treatment of capitellar OCD in young throwing athletes and gymnasts. Stable lesions are managed with rest and activity modification, while unstable lesions, loose bodies, or failed conservative management warrant surgery. Isolated débridement produces suboptimal medium- to long-term results particularly for larger and laterally based lesions, whereas osteochondral autograft or allograft transplantation restores capitellar anatomy with promising return-to-activity rates.
Key Limitation
No pooled outcome data or meta-analytic synthesis is provided, so the superiority of osteochondral transplantation over débridement rests on narrative interpretation rather than quantified effect sizes or rerupture/failure rates.
Original Abstract
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.