Symptomatic Cartilage Defects of the Elbow in the Skeletally Mature

Cartilage injuries and/or defects in the elbow are relatively rare in athletes. These injuries are most commonly seen in overhead throwing athletes or in those involved in upper extremity weight-bearing sports such as gymnastics. 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16 and 17 The most common cartilaginous elbow lesion in athletes is osteochondritis dissecans (OCD), typically of the capitellum 3, 18, 19 and rarely of the trochlea or radial head. 2,10,14,20,21,22,23 and 24 In the spectrum of valgus extension overload, chondral lesions, most commonly degenerative, can be seen in the radiocapitellar joint and posteromedial aspect of the trochlea (Figure 25-1). OCD occurs most frequently in the active, pediatric or adolescent, skeletally immature population but presents in the adult, skeletally mature population as well. OCD in skeletally immature patients is referred to as juvenile osteochondritis dissecans and is beyond the scope of this chapter. A thorough review is included in Chapter 16. OCD in the skeletally mature population is labeled as adult osteochondritis dissecans (AOCD). Although there is little published on AOCD of the elbow, in general AOCD is thought to have a poorer prognosis compared with juvenile OCD. 25, 26 Many authors feel that AOCD lesions likely develop before skeletal maturity but present symptomatically after skeletal maturity. 25, 27 The incidence of AOCD in the elbow is notably low. Weiss et al 25 performed a database review and found only 124 total cases of AOCD in 122 patients from a cohort of 1,835,921 patients the same age; of these, only 2 were located within the elbow.