Osteochondritis Dissecans of the Capitellum: Arthroscopic Microfracture

Background: 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. Indications: 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. Technique Description: 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. Results: Arthroscopic microfracture can relieve the patient's pain, improve motion, remove loose bodies, and initiate fibrocartilaginous filling of the defect. Discussion/Conclusion: Arthroscopic microfracture for osteochondritis dissecans of the capitellum offers a minimally invasive approach with good to excellent outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.