Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum
Background: Osteochondritis dissecans (OCD) of the elbow is an idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement; for patients with persistent symptoms, surgical treatment is often recommended. While traditionally perfor...
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SAGE Publishing
2025-08-01
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| Series: | Video Journal of Sports Medicine |
| Online Access: | https://doi.org/10.1177/26350254251334654 |
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| author | Melissa L. Carpenter BS Jose F. Vega MD Jintong Liu BS Michael J. Murray BS Trevor A. Poulson MS Zeeshan A. Khan BA Juan Bernardo Villarreal-Espinosa MD Nikhil N. Verma MD |
| author_facet | Melissa L. Carpenter BS Jose F. Vega MD Jintong Liu BS Michael J. Murray BS Trevor A. Poulson MS Zeeshan A. Khan BA Juan Bernardo Villarreal-Espinosa MD Nikhil N. Verma MD |
| author_sort | Melissa L. Carpenter BS |
| collection | DOAJ |
| description | Background: Osteochondritis dissecans (OCD) of the elbow is an idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement; for patients with persistent symptoms, surgical treatment is often recommended. While traditionally performed in the supine or prone position, arthroscopic debridement and microfracture of OCD of the capitellum in the lateral decubitus position permits strategic arm positioning and placement of portals to optimize visualization and reduce the risk of damage to neurovascular structures. Indications: Arthroscopic debridement and microfracture in the context of OCD is utilized when conservative management with rest, physical therapy, and nonsteroidal anti-inflammatory drugs does not provide improvement in pain. This technique is also preferred for smaller defects not suitable for fragment fixation or osteochondral autograft transplantation. Technique Description: After induction of anesthesia, the patient is placed in the lateral decubitus position with the operative extremity supported with an arm holder at 90°. The left side is then prepped and draped sterilely. A diagnostic arthroscopy of the elbow is first performed to identify any concomitant pathologies. The OCD defect is then mobilized with a probe to enhance visualization. The lesion is thoroughly debrided with a shaver to create a stable rim and the base decorticated with a curette. An arthroscopic microfracture instrument is used to create microfracture sites at the base of the lesion. Results: It is the senior author’s belief that management of OCD with arthroscopic debridement and microfracture in the lateral decubitus approach provides superior visualization and allows free manipulation of the joint throughout the procedure. This facilitates direct treatment of the OCD lesion to ensure a stable rim is created while permitting comprehensive evaluation of the joint. Additionally, the risk of iatrogenic injury to nearby neurovascular structures while instrumenting the joint is diminished with proximally placed portals. Discussion/Conclusion: Arthroscopic debridement and microfracture for OCD in the lateral decubitus position with the operative extremity supported proximally in an arm holder has been shown to optimize arthroscopic viewing of the OCD lesion, thereby ensuring the lesion is stabilized and comprehensively treated. 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. |
| format | Article |
| id | doaj-art-b7adb7fa0c8a4c62afbad1d45ad04482 |
| institution | Kabale University |
| issn | 2635-0254 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | SAGE Publishing |
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| series | Video Journal of Sports Medicine |
| spelling | doaj-art-b7adb7fa0c8a4c62afbad1d45ad044822025-08-21T12:03:22ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542025-08-01510.1177/26350254251334654Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the CapitellumMelissa L. Carpenter BS0Jose F. Vega MD1Jintong Liu BS2Michael J. Murray BS3Trevor A. Poulson MS4Zeeshan A. Khan BA5Juan Bernardo Villarreal-Espinosa MD6Nikhil N. Verma MD7Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USAUniversity of Colorado School of Medicine, Aurora, Colorado, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USABackground: Osteochondritis dissecans (OCD) of the elbow is an idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement; for patients with persistent symptoms, surgical treatment is often recommended. While traditionally performed in the supine or prone position, arthroscopic debridement and microfracture of OCD of the capitellum in the lateral decubitus position permits strategic arm positioning and placement of portals to optimize visualization and reduce the risk of damage to neurovascular structures. Indications: Arthroscopic debridement and microfracture in the context of OCD is utilized when conservative management with rest, physical therapy, and nonsteroidal anti-inflammatory drugs does not provide improvement in pain. This technique is also preferred for smaller defects not suitable for fragment fixation or osteochondral autograft transplantation. Technique Description: After induction of anesthesia, the patient is placed in the lateral decubitus position with the operative extremity supported with an arm holder at 90°. The left side is then prepped and draped sterilely. A diagnostic arthroscopy of the elbow is first performed to identify any concomitant pathologies. The OCD defect is then mobilized with a probe to enhance visualization. The lesion is thoroughly debrided with a shaver to create a stable rim and the base decorticated with a curette. An arthroscopic microfracture instrument is used to create microfracture sites at the base of the lesion. Results: It is the senior author’s belief that management of OCD with arthroscopic debridement and microfracture in the lateral decubitus approach provides superior visualization and allows free manipulation of the joint throughout the procedure. This facilitates direct treatment of the OCD lesion to ensure a stable rim is created while permitting comprehensive evaluation of the joint. Additionally, the risk of iatrogenic injury to nearby neurovascular structures while instrumenting the joint is diminished with proximally placed portals. Discussion/Conclusion: Arthroscopic debridement and microfracture for OCD in the lateral decubitus position with the operative extremity supported proximally in an arm holder has been shown to optimize arthroscopic viewing of the OCD lesion, thereby ensuring the lesion is stabilized and comprehensively treated. 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.https://doi.org/10.1177/26350254251334654 |
| spellingShingle | Melissa L. Carpenter BS Jose F. Vega MD Jintong Liu BS Michael J. Murray BS Trevor A. Poulson MS Zeeshan A. Khan BA Juan Bernardo Villarreal-Espinosa MD Nikhil N. Verma MD Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum Video Journal of Sports Medicine |
| title | Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum |
| title_full | Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum |
| title_fullStr | Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum |
| title_full_unstemmed | Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum |
| title_short | Elbow Arthroscopy for Treatment of Osteochondritis Dissecans of the Capitellum |
| title_sort | elbow arthroscopy for treatment of osteochondritis dissecans of the capitellum |
| url | https://doi.org/10.1177/26350254251334654 |
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