2020 HONORABLE MENTION

Osteochondritis dissecans (OCD) lesions of the humeral capitellum are prevalent in overhead adolescent athletes, especially throwers. Although the etiology of OCD lesions of the humeral capitellum is largely unknown, it likely results from an overuse injury to the immature capitellum via repetitive valgus overloading. Treatment options include rest from throwing for patients with stable lesions who have an open physis; arthroscopic débridement and microfracture for smaller lesions; and osteochondral autograft transplantation (OAT) for larger, unstable lesions in patients in whom nonsurgical treatment fails.

This video demonstrates the technique for open OAT for the management of an OCD lesion of the humeral capitellum in an adolescent baseball pitcher.

The video provides an overview of the pathogenesis, diagnosis, and management of OCD capitellar lesions. The case presentation of a 14-year-old male baseball player who experiences lateral elbow pain and catching and locking symptoms during pitching is discussed. Evidence of a large osteochondral lesion is observed on radiographs and MRIs. Nonsurgical treatment as well as arthroscopic débridement and microfracture, which was performed 1 year ago, failed in this patient. Therefore, open OAT with the use of a 10-mm diameter graft from the non–weight-bearing portion of the medial femoral trochlea of the ipsilateral knee was indicated.

Postoperatively, the patient's arm was placed in a sling for comfort for 2 weeks, after which formal physical therapy was initiated to regain range of motion and strength. The patient was able to return to sports activity 3 months postoperatively after achieving full range of motion and experiencing no lateral tenderness on physical examination. A supervised throwing program was initiated 6 months postoperatively, with a gradual return to full throwing and pitching activity as tolerated.

OAT is a reliable treatment option for the management of large OCD lesions of the humeral capitellum in immature athletes. Studies have reported high rates of return to play and symptomatic improvement with low donor site morbidity in athletes who undergo OAT.