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World J Orthop. Feb 18, 2016; 7(2): 102-108
Published online Feb 18, 2016. doi: 10.5312/wjo.v7.i2.102
Osteochondritis dissecans of the capitellum in adolescents
Christiaan J A van Bergen, Kimberly I M van den Ende, Bart ten Brinke, Denise Eygendaal
Christiaan JA van Bergen, Department of Orthopedic Surgery, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Bart ten Brinke, Denise Eygendaal, Kimberly IM van den Ende, Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands
Author contributions: van Bergen CJA drafted and finalized the manuscript; van den Ende KIM and ten Brinke B provided the figures; Eygendaal D supervised the writing process; all authors reviewed and commented on the text and approved the final version.
Conflict-of-interest statement: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christiaan JA van Bergen, MD, PhD, Department of Orthopedic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. c.j.vanbergen@amc.nl
Telephone: +31-20-5669111 Fax: +31-20-5669117
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: August 4, 2015
Revised: September 16, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: February 18, 2016
Processing time: 264 Days and 8.9 Hours
Abstract

Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, an OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk. A high index of suspicion is warranted to prevent delay in the diagnosis. Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy. Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach. Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD. Numerous other surgical options have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this article is to provide a current concepts review of the etiology, clinical presentation, diagnosis, treatment, and outcomes of elbow OCD.

Keywords: Osteochondritis dissecans; Cartilage; Elbow; Capitellum; Athletes; Overhead sports; Arthroscopy; Bone marrow stimulation; Adolescent; Osteoarthritis

Core tip: The aim of this article is to provide a current concepts review of the etiology, clinical presentation, diagnosis, treatment, and outcomes of elbow osteochondritis dissecans. This well illustrated paper highlights the need for a high index of suspicion to prevent delay in the diagnosis. Various imaging methods are outlined. Current treatment options are discussed and future directions are provided.