Capitellar OCD


Capitella OCD 1Capitella OCD 2




Adolescents 12 - 20

Boys > girls


Repetitive overhead or loading actitivities

- throwing athletes / baseball

- gymnastics

- tennis


Kida et al Am J Sports Med 2014

- 2433 adolescent baseball players

- incidence of capitellar OCD on screening was 3.4%

- players with OCD had started baseball earlier and had played longer




Panner's disease / osteochondrosis

- child 4 - 8 years old

- entire capitellar epiphysis

- ischaemia and necrosis of the capitellum

- followed by regeneration and recalcification

- benign self limiting disease that resolves with rest




Excessive valgus compression across elbow joint


Common throwing sports / gymnastics

- dominant limb

- repetitive overuse

- valgus overload on radiocapitellar joint 

- injury to the vascular supply of the subchondral bone

- localized avascular necrosis




Dominant arm / history of over-use


Lateral elbow pain


Limited range of motion


Clicking, grinding, catching, locking - loose bodies




Tender over lateral aspect elbow


Loss of extension


Radio-capitellar compression test

- active supination and pronation with arm fully extended


Examine MCL




Kijowski et al Skeletal Radiology 2005

- 50% of capitellar OCD not identified on xray


Capitellar OCDCapitella OCD 1

Localized flattening and translucency                        Lucency in capitellum




Elbow OCD Type 2BElbow OCD Type 2B CT


Capitella OCD 2Capitellar OCD CT




Fluid interface denotes detachment / instability


Capitellar OCD MRIElbow OCD MRI displaced


MRI Classification



- cartilage intact

- no fluid behind lesion



- cartilage breach

- fluid behind lesion


Bexkens et al Should Elbow 2020

- inter-observer reliability of MRI classification

- acceptable reliability for stable v unstable only


ICRS Arthroscopic Classification


Grade 1:  Stable lesion - soft, but cartilage continuous

Grade 2:  Partially discontinuous

Grade 3:  Complete discontinuity but not dislocated

Grade 4:  Empty defect




Central - lateral wall intact, contained, easier to manage

Lateral wall - uncontained lesion


Lateral wall capitella OCDCentral contained defect

Lateral capitellar OCD                                Central contained capitellar OCD




< half diameter radial head

> half diameter radial head




Non operative




Stable lesion

- intact cartilage

- nil detachment / no synovial fluid behind OCD




Protected ROM

- hinged brace

- attempt to reduce axial load

- nil sports until full ROM

- 3-6 months




Sakata et al Am J Sports Med 2021

- nonoperative treatment of 81 youth baseball players

- return to play 70%


Mihara et al Am J Sports Med 2009

- 39 baseball players mean age 13 years

- cessation of throwing, weights, push ups

- healing of lesion in 16/17 patients with open growth plates

- healing of lesion in 11/22 with closed growth plates

- 25/30 early stage lesions healed

- only 1/9 advanced stage lesions healed

- suggest early surgical intervention in advanced OCD

- recommend surgical intervention if no sign of healing in 3-6 months






1.  Failure nonoperative treatment

2.  Unstable lesions

3.  Loose bodies




Westermann et al Orthop J Sports Med 2016

- systematic review of surgical management of capitellar OCD

- 24 studies and 492 patients

- return to sport 64% OCD fixation

- return to sport 71% OCD removal and marrow stimulation

- return to sport 94% osteochondral autograft


Large & salvageable fragments




Drill in situ



Drill in situ




Stable lesion

Failed nonoperative treatment


Elbow OCD InsituElbow OCD Retrograde Drilling

Capitellar OCD viewed via anterior portals, being drilled in retrograde fashion using ACL jig


Arthroscopic technique

1.  Anterograde

2.  Retrograde using ACL jig


B.  Unstable - Fixation




Acute injury

Large fragment

Minimal bony fragmentation




Vumedi open capitellar OCD fixation




Hennrikus et al J Paediatr Orthop 2015

- 26 unstable OCD fixed

- 20/26 healed


Small or unsalvageable fragments




Arthroscopic debridement

Arthroscopic debridement + marrow stimulation

Osteochondral autograft




Debridement versus debridement + microfracture


McLaughlin et al Arthros Sports Med Rehab 2021

- systematic review comparing debridement versus debridement + microfracture

- both procedures improved pain, ROM, outcome scores and return to play

- return to play 40 - 100% after debridement

- return to play 55 - 75% after microfracture

- comparable midterm outcomes


Debridement + microfracture versus osteochondral autograft


Westermann et al Orthop J Sports Med 2016

- systematic review of surgical management of capitellar OCD

- 24 studies and 492 patients

- return to sport 71% OCD removal and marrow stimulation

- return to sport 94% osteochondral autograft


Natural history


Ueda et al Orthop J Sports Med 2017

- 38 elbows treated with fragment removal followed for minimum 5 years

- lesions < half radial head had better outcomes than lesions > half radial head

- increased radiological osteoarthritis in group with smaller lesions


Arthroscopic debridement of loose fragments +/- marrow stimulation




Elbow arthroscopy

Posterior portals

- capitellar OCD viewed by flexing elbow


Arthroscopic technique of debridement and microfracture PDF


Vumedi video capitellar debridement + microfracture


Elbow Scope Capitellar OCDElbow Scope OCD Debridement

Arthroscopic debridement of loose fragments


Elbow Scope OCDElbow scope OCD Microfracture

Arthroscopic debridement of loose fragments and microfracture


Elbow OCDElbow OCD Abrasion

Arthroscopic debridement of loose fragments and abrasionplasty


Capitellar Osteochondral Defects




Osteochondral autograft / mosaicplasty

Osteochondral allograft







Unsalvageable OCD

Loose body

Failed arthroscopic debridement and marrow stimulation




Osteochondral plugs from lateral femoral condyle of knee

Anconeus split approach


Capitellar mosaicplasty surgical technique PDF


Vumedi technique


AO surgery foundation lateral approach to distal elbow




Maruyama et al Am J Sports Med 2014

- 33 male baseball players mean age 13

- mean defect size 1.5 x 1.5

- plugs from lateral femoral condyle

- 91% no pain

- good improvement in ROM

- 31/33 return to sport at 7 months


Matsuura et al Am J Sports Med 2017

- compared mosaicplasty for 43 central lesions versus 44 lateral lesions

- lateral lesions larger and needed more grafts than central lesions

- better ROM and return to sport in central lesions

- more osteoarthritis with lateral lesions

- no difference in outcomes