Osteochondritis Dissecans (OCD)

OCD is a disabling condition that may present with elbow pain, and catching or locking of the elbow joint. The cartilage and the bone under the cartilage are fragmented locally in the capitellum, the outer part of the elbow joint. Initially, the cartilage raises on one-side and interferes with elbow motion causing locking of the elbow joint. In later stages, the fragmented cartilage may fall into the radiocapitellar joint, forming loose bodies.

OCD is commonly seen in 10 to 16 year old baseball pitchers. Its cause is usually trauma. The medial collateral ligament complex may show laxity, which may cause more than usual deviation (valgus force) during the acceleration phase of throwing. With extreme forces on the capitellum, the bone breaks locally and there is shearing of the cartilage. The patient presents with a painful elbow and decreased range of motion. X-rays may be normal or rarely will show irregularities or flattening of the capitellum. However, MRI is diagnostic. It will show discrete area of cartilage and bone damage.

Nondisplaced fractures and pure cartilage lesions may be treated with immobilization and rest. Some surgeons recommend arthroscopic debridement and pinning if there is displacement. After removal of the cartilage, multiple holes are drilled in the defect using a pin to create fibrocartilage. However, more sophisticated treatment method of this condition is with replacement of the cartilage and the defect. For this purpose, we harvest cartilage and bone plugs from the knee to restore the defect. The surgeon maps the defect first then applies multiple osteochondral allografts. We harvest multiple 6 or 7 mm cylindrical shaped cartilage and bone plugs from the non-weight-bearing surface of the knee. Then same size holes are drilled in the elbow cartilage defect. The osteochondral graft plugs are applied with a press-fit effect, thus no fixation is necessary. Early elbow and knee motion is encouraged with braces. In about 8 weeks, the plugs heal and we start strengthening.

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