Osteochondritis Dissecans of the Elbow

The exact cause of Osteochondritis Dissecans is not completely understood. Still, it is believed to result from repetitive trauma or stress to the elbow joint, which disrupts the blood flow to the affected area. This condition is common in athletes, especially those engaged in throwing or repetitive overhead movements, such as baseball pitchers or tennis players. Genetic factors may also play a role, as some individuals may be predisposed to developing this condition. This can also be seen in other body joints, including the knee, hip, ankle, and shoulder.

• Elbow pain in the dominant arm that proceeds gradually and may be activity-related.
• An early sign is losing the ability to fully extend the arm.
• Late signs are catching, locking, and grinding if small fragments of bone and cartilage break off and float freely in the joint space.
• Swelling around the elbow.
• Stiffness and reduced range of motion.
• Arm weakness.

The diagnosis of Osteochondritis Dissecans involves a combination of clinical examination and imaging studies. Dr. Waterman will review the patient’s medical history and inquire about the circumstances surrounding the patient’s symptoms. He will then assess the elbow for pain, swelling, and range of motion.

He will order X-rays to help visualize the bone structure and identify any loose fragments or abnormalities. An MRI provides a detailed view of the bone and cartilage, helping to determine the extent of the damage and whether the cartilage is still attached to the bone. In certain cases, a CT scan may provide additional information about the size and location of the lesion.

Treatment for Osteochondritis Dissecans depends on the severity of the condition and the patient’s age and activity level.

• Nonsurgical Treatment
  • Nonsurgical treatment includes stopping all impact activity and immobilizing the elbow with a brace or splint. This can reduce symptoms and aid in healing for three to six weeks, followed by physical therapy for 6-12 weeks. Anti-inflammatory medications can help alleviate pain and reduce inflammation. Nonsurgical treatment is successful in up to 90% of cases.
• Surgical Treatments
  • Surgery is an option when nonsurgical treatment fails to relieve symptoms and when bone fragments are loose. Surgical options include:

• • • Arthroscopic microfracture – drilling in the bone to stimulate blood flow and healing.
    • Arthroscopic debridement – a minimally invasive procedure where small instruments are inserted into the joint to remove loose fragments and stimulate healing.
    • Open surgery may be necessary to reattach fragments, realign the joint surfaces, or repair the cartilage surface.
    • Bone grafting is an option for severe cases. It involves using a graft of healthy tissue taken from another part of the body to replace the damaged bone. This procedure is called osteochondral allograft transplant surgery (OATS). After surgery, the arm is immobilized in a splint and brace for 4 weeks. Physical therapy is focused on restoring strength and range of motion. Healing takes about six months, after which the patient can return to sports.