Diagnosis and treatment. A capitellar OCD prevalence study used ultrasound as the screening examination and found that it had a 100% positive predictive value. CrossRef PubMed Google Scholar. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Nonetheless the use of ultrasound as a simple and noninvasive tool has been advocated by several writers as a way to screen young, susceptible athletes for asymptomatic lesions as well as to access vascularity of the lesion ( ). Int J Sports Phys Ther. Stage I lesions appear as normally shaped capitellum with several spotted areas whose signal intensity is high but lower than that of cartilage. The involvement of the capitellum is more diffuse, with radiographs revealing loss of the normal contour of the capitellum ( ). With delayed presentation, patients may lack the terminal 15 to 30 degrees of elbow extension ( ). The dominant arm is more commonly involved, although bilateral involvement has been reported ( ). January 2021; DOI: 10.1007/978-3-030-52379-4_6. It can be distinguished from the more benign Panner’s disease, as Panner’s is self-limiting, requires minimal … Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. The lesions can be treated by either conservative or operative methods with good to excellent results reported in most situations.  |  The most common early symptom of a capitellar OCD lesion is a gradual, progressive onset of lateral elbow pain. 32.3 ). The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. 32.2 ). This scheme has been well adopted because of its relative ease of use; however, it has not been shown to correlate well with treatment outcomes ( ). In the elbow, an OCD is localized most commonly at the humeral capitellum. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed.  |  Stage III lesions show a discontinuous and noncircular capitellum chondral surface. Athletes with OCD of the capitellum often complain of diffuse, nonspecific pain with activity. Patients who present with OCD of the capitellum are typically athletes between ages 11 and 21 years ( ). Unlike Panner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. 4th ed. 32.6 ). It is defined as a localized fragmentation of bone overlying the capitellum cartilage. Clin Sports Med. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. A collaborative approach to prevent medial elbow injuries in baseball pitchers. In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. Currently, the key to successful treatment is early detection. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Humeral capitellum osteochondritis dissecans is believed to affect 4.1 of every 1000 males. devised the first classification scheme for capitellum OCD lesions based on AP radiographs: Grade I lesions demonstrate a stable lesion with a translucent cystic shadow in the lateral or middle capitellum. The pathophysiology of OCD resembles that of mechanical trauma to articular cartilage. For this reason, the senior author (CWN) often exercises athletes in the office (i.e., throwing baseballs) to provoke their symptoms. Elbow involvement in osteochondritis dissecans is rare. Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. Hence, this compromise of the subchondral support structure promotes articular cartilage fragmentation and loose body formation ( ). OCD usually causes pain during and after sports. The elbow and its disorders. CLINICAL CASE PRESENTATION . 2019 Mar;12(1):1-12. doi: 10.1007/s12178-019-09528-8. 1999 Nov-Dec;27(6):728-32. doi: 10.1177/03635465990270060701. THE ALFRED I. DUPONT INSTITUTE . This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery. In the elbow, supplemental views such as 45 degrees flexion or oblique views may help to demonstrate the lesion. However, its etiology remains unknown. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Supplemental views helpful for visualizing more of the capitellar surface include an AP image of the distal humerus with the beam angled 30 degrees cephalad, and an AP view with 45 degrees of elbow flexion, otherwise known as the Takahara view ( ) ( Fig. Philadelphia: WB Saunders; 2009. p. 288–96. Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). Finally, it also commonly occurs in persons who participate in racquet sports and in weight lifting. Side view of a pitcher at the point of maximal shoulder and elbow stress. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. Furthermore, patients’ lesions often heal their and patients return to full activities despite the lack of full radiographic healing. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Am J Sports Med. Takahara radiographic view of the elbow in a skeletally immature athlete. Which form loose bodies within the joint. OSTEOCHONDRITIS DISSECANS OF THE CAPITELLUM . Repetitive stress to and compression of this tenuous blood supply may cause ischemia of the subchondral bone within the capitellum and the characteristic osteonecrosis observed in OCD. When rest is difficult to accomplish, bracing, use of a sling, or even a period of casting is used. Osteochondritis dissecans (OCD) of the elbow is increasing in prevalence in American pediatric populations. A grade IV lesion is either an empty defect, a defect with a dislocated fragment, or a loose fragment lying within the bed. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 2008;33(8):1380–3. Stage II is marked by several spotted areas of higher intensity than cartilage. Ultimately, a return to activities is appropriate only after there is complete resolution of symptoms and the athlete has regained full range of motion and strength not only about the elbow but also of the shoulder girdle ( ). Stage IV lesions are characterized by separation from the capitellum chondral surface by a high signal interface. Introduction. ORTHOPAEDIC DEPARTMENT . National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. Provoking compressive forces on the capitellum commonly occur in the dominant arm of overhead throwing athletes and from weight-bearing stress in gymnasts in the second decade of life. OCD can mean one or more flakes of articular cartilage have become separated. Unfortunately, except for a few circumstances, there is no consensus at this point on an acceptable system. This same phenomenon extends to OCD of the capitellum. Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. Many classification systems have been proposed to help guide the diagnosis and management of capitellar OCD lesions. Nonoperative treatment for osteochondritis dissecans of the capitellum. June 4, 1996. Use of repeated imaging, although intuitively a good idea, is not established as a viable method to determine the appropriate timing of return to activities. Each of these interventions has had variable short-term outcomes, and the ideal management strategy has yet to be determined. Through a cadaveric ink-injection study of the skeletally mature elbow, determined that the main arterial contributors to the lateral elbow are the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The elbow is positioned in approximately 45 degrees of flexion with the beam aimed perpendicular to the forearm. Contained lesions seem to have better outcomes than uncontained lesions. described a method to visualize the articular surface and subchondral bone by utilizing long-axis and short-axis views of the anterior and posterior capitellum. These lesions, although often asymptomatic, can cause a significant interruption in a young athlete’s sports participation and in his or her day-to-day lives when the disease goes undiagnosed or is allowed to progress until significant symptoms occur. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Classic radiography finding of capitellar OCD with radiolucency of the anterolateral capitellum. Grade III lesions show complete discontinuity but have not dislocated. This point is defined as early acceleration with the shoulder near its point of maximal external rotation. Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. 32.4 ). With time, the overlying articular cartilage begins to break down and is increasingly vulnerable to shear stress because of inadequate subchondral osseous support, leading to separation, fragmentation, and loose body formation ( ). Capitellar OCD is relatively uncommon but Osteochondritis dissecans (OCD) of the capitellum is an overuse injury most commonly seen in young overhead athletes such as throwers and gymnasts. This disorder is an idiopathic osteochondrosis of the entire immature capitellum. On the contrary, unstable lesions possess one of the following characteristics: a closed capitellar growth plate, lesion fragmentation, or restricted elbow motion ≥ 20 degrees. Investigators have found high sensitivity (89% to 100%) of MRI for detecting unstable lesions when all four of the following Kijowski criteria are present: (1) a rim of high signal on T2-weighted images, (2) surrounding cysts, (3) a fluid-filled osteochondral defect, and (4) a thin high-intensity fracture line on T2-weighted images ( ). Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. Crepitus at the elbow may be palpable with flexion and extension. The Research in Osteochondritis of the Knee (ROCK) study group has come to define OCD as “a focal, idiopathic alteration of subchondral bone with risk of instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis” ( ). CrossRef Google Scholar. Gymnasts, in general, fare … In the evaluation for suspected osteochondritis dissecans of the capitellum, standard elbow radiographs, including anteroposterior (AP), oblique radial head, and lateral views, should be obtained ( Fig. Grade II lesions possess a clear zone between the lesion and the adjacent subchondral bone. Ultimately the decision on how to treat a particular lesion is determined both by the extent of the lesion and by the athlete’s desire to participate in the chosen sport. Indian J Orthop. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. It usually occurs in baseball players, but can occasionally happen in other athletes that throw overhead. Nonoperative management when OCD is diagnosed at an early stage can be successful and has been the mainstay of treatment in skeletally immature patients for many years. Bexkens R, Oosterhoff JHF, Tsai TY, Doornberg JN, van den Bekerom MPJ, Eygendaal D, Oh LS. Successful conservative treatment requires the reduction or elimination of all stress for a period of at least 6 weeks to allow the subchondral bone to stabilize, heal, and support the overlying cartilage. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. 32.5 ). Athletes rarely recall any specific trauma to the elbow. 2001 Jul;20(3):565-90. doi: 10.1016/s0278-5919(05)70270-2. As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. Elbow pain seen in the at-risk athlete, such as a baseball player (in particular, a pitcher) or gymnast, should raise suspicion for OCD. Athletes often present to the physician’s office after a period of rest, lowering the diagnostic yield of physical examination. Although many theories have been proposed, such as ischemia, genetic factors, and microtrauma, the etiology of OCD remains unclear. Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes. Unlike Panner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. 0 . Clipboard, Search History, and several other advanced features are temporarily unavailable. Based on these imaging findings a diagnosis of osteochondritis dissecans (OCD) of the capitellum was made. A localized injury and subsequent separation of articular cartilage and subchondral bone of the capitellum ; Epidemiology ... - Osteochondritis Dissecans of Elbow B 6/7/2020 262 . In more severe cases, athletes may develop mechanical symptoms, such as catching, clicking, and locking, suggesting the presence of intraarticular loose bodies. WILMINGTON, DELAWARE . Osteochondritis Dissecans of the Elbow. Grade II lesions are stable when probed but demonstrate partial discontinuity. However, we are very careful with this treatment arm of the algorithm because the elbow loses functional range of motion faster than most joints in the body when it is immobilized. Yoshida T, Kim WC, Oka Y, Nakase M, Nishida A, Wada H, Arai Y, Kubo T. J Orthop. Shaughnessy WJ. OCD of the capitellum is more commonly found in male adolescent athletes engaging in repetitive overhead activities and has been associated with baseball, gymnastics, tennis, weight lifting, wrestling, and cheerleading. Epub 2008 Dec 4. In this system, grade I lesions are stable with continuous but softened areas of intact cartilage. Osteochondritis dissecans (OCD) of the outer elbow side of the arm bone, or capitellum, is a condition that results from repetitive trauma to the capitellum. Radiographs are the most common initial modality for screening patients with suspected OCD. The exact etiology of OCD is not clear, but it is believed that repetitive trauma is the primary cause. NLM It occurs in a younger age group (4–12 years) than capitellar OCD and is predominantly found in boys. Panner’s disease must be considered in the differential diagnosis of a young athlete with elbow pain. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Changes evolve on T2-weighted imaging as the lesion progresses ( ). Deciding when healing has occurred to an extent great enough to start a slow and planned progression back into daily functioning and, ultimately, athletic activities is difficult. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising. 2020 Nov 20;9(11):e1727-e1730. OSTEOCHONDRITIS DISSECANS OF THE RADIAL HEAD IN A YOUNG ATHLETE: A CASE REPORT. As the understanding of these lesions grows and better methods for diagnosing and treating them become known the ultimate effect of OCD may lessen to insignificance. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. This site needs JavaScript to work properly. Although intravenous gadolinium contrast enhancement of the lesion may suggest vascularity and thus viability of a fragment, MR arthrography has not been shown to provide any added benefit in assessing for the presence or stability of OCD lesions ( ). CRAIG MORGAN, M.D., Attending, Orthopaedic Surgery. J Hand Surg Am. However, once an athlete complains of clicking or locking, regardless of the timeliness of diagnosis and the patient’s age, the likelihood that conservative management will be successful decreases. Capitellar osteochondritis dissecans (OCD) is one of the most common causes of elbow pain and dysfunction in adolescent athletes. Must distinguish from Panner’s Disease, transient osteonecrosis of the capitellum which typically occurs at younger ages, 5-12yo. proposed a classification scheme of capitellar OCD lesion stability based on T2-weighted MRI sequences. Osteochondritis dissecans (OCD) is a musculoskeletal condition that occurs primarily during the maturation of the skeleton. Suspicion of … J Shoulder Elbow Surg. Ultimately, repetitive stress of this nature leads to disruption of a localized portion of the subchondral bone and, if allowed to progress, the overlying articular cartilage. Patients may also complain of accompanying elbow stiffness and loss of motion. Osteochondritis dissecans of the elbow occurs in up to 3% of young athletes. devised a more simplified classification, assigning lesions as stable or unstable. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. Please enable it to take advantage of the complete set of features! Osteochondritis dissecans of the capitellum in fraternal twins: case report. Genetic factors are thought to play a secondary role in the pathogenesis. An axillary view of the bent elbow, taken in the style of a knee Merchant view, may also provide better visualization of the capitellum as well as the posteromedial aspect of the elbow, where loose bodies are often found ( ) ( Fig. In the long term OCD can lead to subsequent dege… Takeba, J, Takahashi, T, Hino, K, Watanabe, S, Imai, H, Yamamoto, H. Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. A major disadvantage of ultrasound is the high variability in its accuracy, which is based on the skill and experience of the operator ( ). Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. Late findings include the presence of loose bodies, degenerative changes, and radial head enlargement.  |  In the talus, 96% of lateral lesions and 62% of … Osteochondritis dissecans also occurs in females, most notably gymnasts. USA.gov. Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. Gardiner TB. Curr Rev Musculoskelet Med. Ultrasonography is another potential diagnostic imaging tool for capitellar OCD. As the natural history of the condition is one of progressive impairment and joint degeneration, efforts have been made to improve both non-operative and operative treatment. In early-stage lesions, the T1-weighted MR image demonstrates uniform low-intensity changes in the superficial capitellum, although the T2-weighted imaging findings remain normal. The separated fragments are sometimes called “joint mice”. MRI has proved useful for better characterizing OCD lesions and guiding treatment. Seen primarily in young overhead athletes such as baseball players, the condition is thought to be secondary to repetitive compressive and shearing forces that are exerted by the radial head on the humeral capitellum during the throwing motion. Unfortunately, the ability to prognosticate when conservative treatment will be successful is not well established, and the decision whether to initiate nonoperative versus operative management in capitellar OCD focuses on the extent of disease, the time from onset of symptoms, and the patient’s expectations and desires. The stability of OCD lesions has a significant impact on prognosis and treatment and can be predicted on MRI in some cases. Clin Sports Med. Along the same lines, female gymnasts invoke a similar injury mechanism through repetitive loading of the radiocapitellar joint with their arms in extension ( ). 2018 Jul-Aug;52(4):344-352. doi: 10.4103/ortho.IJOrtho_322_17. Osteochondritis dissecans (OCD) of the humeral capitellum is a sports-related disorder in young athletes, especially baseball players and gymnasts. Osteochondritis Dissecans of the Capitellum. Overhead athletes place the medial elbow stabilizing complex under significant repetitive stress with consequent lateral elbow compression and shear forces. Osteochondritis Dissecans of the Capitellum. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Osteochondritis dissecans (OCD) of the capitellum is an injury that often afflicts young athletes, especially young gymnasts and baseball pitchers. 2. Grade I Osteochondritis Dissecans in a Young Professional Athlete. Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. eCollection 2017 Dec. Osteochondritis dissecans of the humeral capitellum. Elbow is flexed 110 to 120 degrees, and the shoulder is slightly externally rotated. Rest and antiinflammatory medications are typically effective in relieving the pain, features that may contribute to the delayed presentation that often occurs with this pathology. OCD of the humeral capitellum remains a difficult problem to treat. Grade III lesions are associated with loose bodies. The elbow should be examined for any evidence of effusion. Knee Surg Sports Traumatol Arthrosc. 4 . Repetitive microtrauma in the susceptible elbow initiates fatigue fracture, resorption, and ultimately fragment separation from the underlying subchondral bone, as demonstrated by through rabbit models. Although radiographic findings are often negative in the early phases of the disease, the most classic finding is a focal radiolucency or irregularity in the anterolateral capitellum ( Fig. 14. 2009 Feb;37(2):298-304. doi: 10.1177/0363546508324970. Elbow radiographs may be normal in the early stages of OCD of the capitellum. 32.1 ). Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. The blood supply to the capitellum arises primarily from posterior perforating vessels that traverse the epiphyseal articular cartilage without metaphyseal collateral circulation ( ). An arthroscopic classification was developed by and later modified by the International Cartilage Repair Society. doi: 10.1016/j.eats.2020.07.022. Mihara K, Tsutsui H, Nishinaka N, Yamaguchi K. Am J Sports Med. 13. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. There is a lack of consensus on what MRI findings do or do not indicate instability; however, most writers believe that unstable OCD lesions can be identified on T2-weighted imaging from a fluid signal between the OCD and the underlying bone, as well as from a discrete round high–signal intensity area representing a cyst under the OCD lesion ( ) ( Fig. 2018 Aug;13(4):726-736. Unlike OCD, Panner’s disease is a self-limiting process that normally resolves completely with activity modification and rest ( ). 2001 Jan;20(1):1-9. doi: 10.1016/s0278-5919(05)70243-x. The treatment of patients with capitellar osteochondritis dissecans is primarily determined by the stability of the osteochondritis dissecans lesion. Many writers suggest that the timeline may be as long as 6 months to allow complete healing. It may progress to become elbow osteoarthritis. Arthrosc Tech. The presence of these OCD lesions is now better recognized, but their etiology is often not known and is certainly multifactorial in many instances. Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. 2017 Sep;26(9):1629-1635. doi: 10.1016/j.jse.2017.03.010. Stable lesions are those that heal with rest and are characterized by an open capitellar growth plate, contained flattening or radiolucency of the subchondral bone, and decent range of motion. Arthroscopy. HHS Computed tomography (CT) may be used to better define the osseous anatomy and subchondral bone, and CT arthrography can more accurately assess for loose bodies ( ). A disadvantage to consider with CT is the radiation exposure imparted on the young athlete. With this maneuver, passive forearm pronation and supination with the elbow in midrange flexion and extension during application of an axial load recreates pain at the radiocapitellar joint. An elbow ligamentous stability examination should be performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability. In later stages, the capitellar surface may flatten and the lesion is often surrounded by a rim of sclerotic bone ( ). Despite the uncertainty of its etiology, symptomatic OCD of the capitellum arises primarily from repetitive stress to the elbow ( ). Physical examination reveals tenderness over the radiocapitellar joint in the posterolateral elbow in some cases. Maselli F, Patuzzo a, Siracusa osteochondritis dissecans capitellum, Siracusa a, Di Filippo,! Sclerotic bone ( ) K, Tsutsui H, Nishinaka N, Yamaguchi K. Am Sports... Outside of the smooth articular surface begins to separate from the damaged underlying subchondral bone elbow stress flexion... Lesions as stable or unstable adolescent athlete aetiology is still unknown, it been... Curettage of the smooth articular surface begins to separate from the capitellum are typically athletes between ages 11 and years... With traumatic insult, the key to successful osteochondritis dissecans capitellum is based on T2-weighted MRI sequences collateral ligament insufficiency and rotatory... 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