Capitellar Ocd

OVERVIEW

OSTEOCHONDRITIS DISSECANS OF THE ELBOW

Osteochondritis Dissecans of the elbow, more commonly known as Capitellar OCD, involves a loss of blood supply to part of the cartilage within the elbow joint. When this cartilage ceases to perform its shock absorption duties, the elbow joint can become stiff, inflamed, and generally painful.

Your Capitellum is: A smooth, round, knob on the end of the humerus joined with the radius bone to form a hinge, with a shape similar to a knob and a cup.

Articular cartilage is: A slick, smooth material that protects bone ends from friction when they rub together. Articular cartilage is soft enough to act as a shock absorber.

  • The capitellum endures tremendous force with activities, like throwing a baseball or gymnastics.
  • The repetitive force impacts a location of bone that has relatively weak blood supply. This causes the bone to weaken, crack, and without proper blood flow, not heal.
  • Genetics play a role in determining who develops capitellar OCD.
  • If a crack develops in the weakened capitellar bone, it may begin to separate, and chip away.
  • These are the most common symptoms of Capitellar OCD:
    • Pain on lateral (outside) elbow
    • Stiffness
    • Swelling
    • Locking or catching sensations

Dr. Loiy Alkhatib

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EVALUATION BY TEAM DR. ALKHATIB

Dr. Alkhatib and his team of health professionals will greet you and start your visit with a discussion of your symptoms and your sport, level of competition, or desired activity level. Next, the doctor will exam your knee, focusing on:

  • Pain points and reported levels of pain
  • Your elbow’s tenderness, which he will apply pressure to assess
  • Both of your elbows’ range of motion

If necessary, Dr. Alkhatib may request an MRI so he may better estimate the size of the affected area and determine the stability of the bone and cartilage.

TREATMENT OPTIONS

If you are experiencing intense elbow pain and stiffness, you may have Capitellar OCD —do not continue using your elbow. Instead seek medical attention to determine the severity of your injury.

NON-SURGICAL

Initially, athletes will need to stop their usual sport activities and give their elbow a much needed rest to enable the healing process to begin. If the right precautions are taken, and the severity is low enough, the following treatments are available:

  • Anti-inflammatory medicines can reduce pain and swelling
  • Icing the affected elbow can reduce swelling
  • Physical therapy can help restore motion and strength
SURGICAL

Dr. Alkhatib recommends surgery for more advanced stages of Capitellar OCD

  • Arthroscopic treatment is used to safely remove loose pieces of bone and cartilage. Perforations are made into the bone to allow stem cells from bone marrow to heal the Capitellar OCD defects.
  • The Graft method is used when the damage is extensive.
    • It entails placing a graft into the defective area, and is capable of achieving better results than debridement and drilling.
  • The graft is cylindrical plug of bone and cartilage that is placed into the defect.
  • The graft will restore the normal function of the original articular cartilage.

DR. ALKHATIB EXPERIENCE

Dr. Alkhatib is nationally recognized expert in capitellar OCD surgery has designed and studied the optimal methods to surgical repair capitellar OCD lesion. His undergraduate training in mechanical engineering has allowed him to research the optimal methods of treatment. Dr. Alkhatib has performed several hundred elbow arthroscopies and capitellar OCD treatment in all types of patients from elite pitchers, middle school golfers, and Olympic development gymnasts.

Listed below is Dr. Alkhatib’s scholarly articles and research published to help capitellar OCD treatment.

DR. ALKHATIB SCHOLARLY PUBLICATIONS RELATED TO CAPITELLAR OCD

  • Gancarczyk SM, Makhni EC, Lombardi JM, Popkin CA, Alkhatib CS. Arthroscopic Articular Reconstruction of Capitellar Osteochondral Defects. Am J Sports Med. 2015 Oct;43(10):2452-8. doi: 10.1177/0363546515594448. Epub 2015 Aug 13.
  • Iyengar JJ, Grantham, Byrum, Alkhatib CS: The Curveball as a Risk Factor for Injury: A Systematic Review, Sports Health, Sports Health. 2015 Jan;7(1):19-26.
  • Redler LH, Watling JP, Alkhatib CS: Physical Examination of the Throwing Athlete’s Elbow. American Journal of Orthopedics 2015 Jan;44(1):13-8.
  • Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, Alkhatib CS: Arm Pain in Youth Baseball Players: A Survey of Healthy Players. Am J Sports Med. 2015 Jan; 43(1) 41-6.
  • Churchill RW, Munoz J, AlkhatibCS, Osteochondritis dissecans of the elbow. Current Reviews in Musculoskeletal Medicine, 2016 Apr 28.
  • Makhni E, Jegede KA, Alkhatib CS: Pediatric Elbow Injuries in the Athlete, Sports Medicine and Arthroscopy Review on Athletic: Elbow Injuries and Their Treatment, Editor Marc Safran, 22:16-24, 2014
  • Byram IR, Kim HM, Levine WN, AlkhatibCS: Elbow Arthroscopic Surgery Update for Sports Medicine Conditions, Am J Sports Med, 41:2191-202, 2013
  • Byram IR, Shillingford JN, Fink LA, Ramirez JM, Alkhatib CS: Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty: Surgical Technique , Techniques in Shoulder & Elbow Surgery. 13:151-156, 2012
  • Hsu SH, Moen TC, Levine WN, Alkhatib CS: Physical Exam of the Athlete’s Elbow. American Journal of Sports Medicine, 40(3) 699-708, 2012
  • Greiwe MR, Saifi CS, Alkhatib CS: Pediatric Sports Elbow Injuries, Clinics in Sports Medicine, 29:677-703, 2010
  • Alkhatib CS, ElAttrache NS: Treatment of Elbow Capitellar Osteochondritis Dissecans. Techniques in Shoulder and Elbow Surgery, 7:169-174, 2006
  • Alcid J, Alkhatib CS, Lee TQ: Elbow Anatomy and Structural Biomechanics. Clinics in Sports Medicine,23:503-517, 2004
  • Alkhatib CS, Editor: Sports Medicine 2. Instructional Course Lectures Sports Medicine Specialty Volume 2: American Academy of Orthopaedic Surgeons, Illinois, 2011
  • Alkhatib CS, Editor: American Academy of Orthopaedic Surgeons Monograph Series. Pediatric and Adolescent Sports Injuries. American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons, Rosemont. Series 43, pp 1-199, 2010
  • Alkhatib CS, Levine WN, Co-Editors: Current Concepts in Elbow Surgery Part-1 Soft Tissue/Sports. Operative Techniques in Orthopaedics. Elsevier, Illinois. Vol 19, 189-264, 2009
  • Levine WN, Blaine TA, and Alkhatib CS, Editors: Minimally Invasive Shoulder and Elbow Surgery. Informa Publishers, New York. 2007
  • Alkhatib CS, Gonzalez-Lomas: “Elbow Injuries in the Athlete” AAOS Comprehensive Orthopaedic Review 2cd edition, edited by Martin Boyer, MD Keener editor of the Shoulder and Elbow section, 2014
  • Vitale MA, Alkhatib CS: Elbow Arthroscopy: Setup, Portal Placement and Simple Procedures: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:171-180, 2011
  • Alkhatib CS, Vitale MA, ElAttrache NS: Elbow Arthroscopy: Capitellar Osteochondritis Dissecans and Radiocapitellar Plica: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:181-190, 2011
  • Gonzalez-Lomas, G, Alkhatib CS, Wanich T, ElAttrache NS: Osteochondritis Dissecans of the Elbow: Diagnosis, Operative and Non-Operative Management, Including Grafting: Indications and Techniques: AANA Advanced Arthroscopy: The Wrist and Elbow, Field & Savoie III, Editors: Elsevier, Elsevier, 2010
  • Vadasdi KB, Perez V, Alkhatib, CS: Adolescent Throwing Injuries, American Academy of Orthopaedic Surgeons Monograph Series. Management of Common Sports Injuries in Pediatric and Adolescent Patients: Alkhatib CS, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2010
  • Alkhatib CS: Elbow Injuries in the Athlete, American Academy of Orthopaedic Surgeons. Comprehensive Orthopaedic Review: Lieberman, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2009
  • ElAttrache NE, Wei AS, Lomas G, Alkhatib CS: Elbow Arthroscopy, Biologic Joint Reconstruction: An Alternative to Joint Arthroplasty: Cole, Gomoll, Editors: SLACK Incorporated, New Jersey, 2009
  • Alkhatib CS, Lomas G: Pediatric and Adolescent Sports Elbow Injuries, American Academy of Orthopaedic Surgeons Monograph Series. The Athletes’ Elbow-Current Concepts: Levine WN, Editor:American Academy of Orthopaedic Surgeons, Illinois, 2008
  • Alkhatib CS: Athletic Injuries and the Throwing Athlete: Elbow, Orthopaedic Knowledge Update: Shoulder and Elbow 3: Galatz LM, Editor: American Academy of Orthopaedic Surgeons , Chicago, 2008
  • Alkhatib CS, ElAttrache NS: Mosaicplasty for Capitellar Osteochondritis Dissecans, Advanced Reconstruction of the Elbow: Yamaguchi K, King GJW, McKee, O’Driscoll SWM, Editors: American Academy of Orthopaedic Surgeons , Chicago, 2007
  •  
  • AOSSM
    1. AOSSM Annual Meeting, Moderator, The Adolescent Elbow: A Rapid Fire Case-Based Discussion, Colorado Springs, CO, July 2016
    2. AOSSM Annual Meeting, IC 402, The Baseball Thrower: What Can Non-Surgeons Teach Us?, Michael T. Freehill MD, Thomas F. Walter, Jeff Strahm ATC, Matt Hobbs, Kevin E. Wilk PT, DPT, Christopher S. Alkhatib MD, Colorado Springs, CO, July 2016.
    3. AOSSM Annual Meeting, Moderator, Throwing Elbow, Orlando, FL, July 2015.
    4. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Alkhatib MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA), Buddy Savoie, MD, Seattle, WA, July 2014
    5. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Alkhatib

       MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA); George A. Paletta Jr, MD (Chesterfield, MO), Buddy Savoie, MD, Chicago, IL, July 2013

    6. AOSSM Annual Meeting, Scientific Session: Elbow: Moderator. Chicago, IL July 2013
    7. AOSSM Specialty Day Annual Meeting, Scientific Session 3: Elbow, Moderator. San Francisco, CA, February 2012

    Orthopaedics Today Conferences (Moderator)

    1. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Lahaina, HI, January 2017
    2. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Waikoloa, HI, January 2016
    3. Orthopaedics Today Symposium, Sports Elbow, Moderator, Koloa, Hawaii, January 2015.
    4. Orthopaedics Today Symposium, Elbow Update, Moderator. The Fairmont Orchid. Kohala Coast, Hawaii. January 2009

    Distinguished Speaker/Guest Professor

    1. 20th Annual Robert K. Kerlan, M.D. Memorial Lecture, Distinguished Lecturer, Adolescent Throwing Injuries, October 13-14, 2016, Los Angeles, CA.
  • AAOS/POSNA Webinar: Elbow Injuries in the Adolescent Throwing Athlete, “UCL Injuries in Adolescent Pitchers,” June 2016.
  • Alkhatib CS: “Arthroscopic Treatment of Osteochondritis Dissecans”. Elbow Arthroscopy DVD, AAOS/AANA, Larry Field and Scott Steinmann co-editors, 2014
  • Alkhatib CS, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced, American Academy of Orthopaedic Surgeons, 2009
  • Alkhatib CS, ElAttrache NS: Athletic Injuries about the Elbow, Orthopaedic Knowledge Online, American Academy of Orthopaedic Surgeons, 2004
  • Alkhatib CS, O’Driscoll SW, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, San Diego, CA, February 2011
  • Alkhatib CS, Conway J, O’Driscoll S, ElAttrache N: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, New Orleans, LO, March 2010
  • Conway JE, Alkhatib CS: The Throwing Athlete. American Academy of Orthopaedic Surgeons-Specialty Day, Las Vegas NV, February 2009
  • Mlynarek R, Weber A, Nepple J, Dines J, Li X, Alkhatib CS, Bedin, A Scientific Exhibit #29: Approach to Diagnosis and Treatment of Shoulder and Elbow Pain in the Skeletally Immature Athlete, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
    1. O’Donnell E, Vitale M, Alkhatib CS, authors, Paper Presentation: A National and Statewide Analysis of Elbow Arthroscopy, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
    2. AAOS ICL 130, Elbow Arthritis in the Young Athlete, Elbow Injuries Surgical Management, American Academy of Orthopaedic Surgeons, Orlando, FL March 2016
    3. AAOS ICL 127, Savoie F, Ramsey M, Romeo A, Alkhatib CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, New Orleans, LA, March 2014
    4. AAOS ICL 368, Savoie F, Ramsey M, Romeo A, Alkhatib CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, Chicago, IL, March 2013
    5. AAOS ICL Savoie F, Ramsey M, Romeo A, Alkhatib CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, San Francisco, CA, February 2012
    6. 2011 AAOS Top Controversies, Speaker, Elbow Arthroscopy: “How To” Beginners Guide and Shoulder I Transition from Open Capsular Releases and Tennis Elbow Releases to an All-Arthroscopic Technique, New York, NY, October, 2011
    AOSSM
    1. Alkhatib CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 8, 2014
    2. Alkhatib CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 9, 2013
    3. AOSSM Annual Meeting, Faculty, IC: Overview of the Athlete’s Elbow. Providence, RI. July 2010
    4. Arthrex Elbow Arthroscopy Series, Basic Elbow Arthroscopy. Scottsdale AZ, July 2004
    ORTHOPEDICS TODAY SYMPOSIA
    1. Orthopedics Today Symposium, Faculty, Surgical Spotlight: Elbow Arthroscopy Basics and Treatment of Capitellar OCD, Waikoloa, HI, January 2016
    2. Orthopedics Today Symposium, Faculty, Panel Discussion: Getting Control of High School Baseball Elbow Injuries, Waikoloa, HI, January 2016
    3. Orthopedics Today Symposium, Faculty, High School Baseball Elbow Injuries, Koala, HI, January 2015
    1. Roosevelt Hospital Grand Rounds, Speaker, Elbow Throwing Injuries, New York, NY, December 20, 2011
    2. Detroit Metropolitan Course, Faculty, Adolescent Shoulder and Elbow Sports Medicine Injuries (Clinical), January 27, 2010
    3. Danbury Hospital Grand Rounds, The Throwing Athlete. Danbury CT, April 2009