Capitellar OCD



Adolescents & young adults


Usually between 12 - 21 years 


Throwing athletes / gymnasts


Little Leaguer's Elbow

- combination of capitellar OCD and MCL injury

- a repetitive throwing injury / seen in pitchers




1.  Trauma & Overuse


Common throwing sports / gymnastics

- dominant limb predominates

- repetitive overuse

- valgus overload on radiocapitellar joint 

- fatigue failure of the subchondral area 

- overlying cartilage fails under shear stress & separates


Capitellum loaded more heavily

- less able to take load than radial head articular surface

- especially if have some slight eccentric loading which can occur in throwing athlete or gymnast


2.  Ischaemia


Predominant blood supply to capitellum from posterior vessels

- histopathology shows osteonecrosis


Pappas Classification   


Category 1  - patients < 13 years of age 

Category 2  - 13 years to adulthood 

Category 3  - adults 


Found better prognosis with younger patients 

- especially with open capitellar growth plate

- respond better to non operative treatment




Dominant arm / history of over-use


Pain activity related


Limited range

- very common presentation


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


Iwase's Classification Xray


Grade 1

- localised flattening and translucency


Capitellar OCDElbow OCD


Grade 2


A:  Small fragment without sclerosis

B:  Small fragment with sclerosis


Elbow OCD Type 2BElbow OCD Type 2B CT


Grade 3

- in situ loose body




Panner's disease / osteochondrosis

- child 4 - 8 years old

- entire capitellum involved

- not sure if is earlier spectrum of same disease




Fluid interface denotes detachment / instability


Capitellar OCD MRI




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




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 (Grade 2A and Grade 3)

- suggest early surgical intervention in advanced OCD

- recommend surgical intervention if no sign of healingin 3-6 months






1.  Failure non operative treatment

2.  Loose bodies

3.  Instability / displacement


Large / salvageable fragments


A.  Stable / Drill in situ


Elbow OCD InsituElbow OCD Retrograde Drilling


Arthroscopic technique

- anterograge via anterolateral portal if possible

- retrograde via ACL jig / posterolateral portal with elbow flexed


B.  Unstable / Fixation


Arthroscopic technique

- via soft spot portal


Takahara et al JBJS Am 2007

- demonstrated fragment fixation or reconstruction better than removal

- fragment fixation with bone graft


Small / unsalvageable Fragments


A. Arthroscopic Debridement


Elbow Scope Capitellar OCDElbow Scope OCD Debridement


Schoch et al Arthroscopy 2010

- arthroscopic debridement in 13 patients

- follow up average 3 years

- symptomatic relief

- 6/13 had to cease some sport


B.  Microfracture


Elbow Scope OCDElbow scope OCD Microfracture


C.  Abrasion


Elbow OCDElbow OCD Abrasion


Large Chondral Defects


A.  Mosaicplasty


Ovesen et al J Should Elbow Surg 2011

- 10 patients treated with mosaicplasty

- average age 21

- incorporation in all patients

- significant improvement in Mayo elbow scores