Courtesy: Dan Zlotolow, Shirner’s hospital for Children, USA
Repetitive load to the outside of the elbow, common in pitchers, gymnast, and wrestlers, can lead to a breakdown of the blood supply to the capitellum of the elbow joint. The capitellum is the end of the humerus bone on the lateral column, articulating with the radial head. The capitellum bears 60% of the weight of the entire elbow joint, and is susceptible to injury from valgus overload. Over time, the loss of blood supply results in avascular necrosis (death) of a portion of the capitellum, leading to pain and loss of motion at the elbow. The area of necrosis is called an osteochondritis dissecans (OCD) lesion. Multiple procedures can be performed to manage OCD lesions, depending on the size and severity. If minimal bone has been lost and the cartilage is damaged, microfracture has shown some good but inconsistent results. If there is a large bony and cartilage defect, these can be replaced with cartilage and bone from the knee, known as an osteochondral autograft technique (OAT). We and others have demonstrated that the OAT procedure has an approximately 90% success rate in returning patients to competitive sports.
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