Hypothesis: Advanced lesion of osteochondritis dissecans (OCD) of the elbow should be treated surgically by the protocol “arthroscopic debridement with or without reconstruction according to the lesion size.” Materials and Methods: In total, 131 advanced OCD patients (International Cartilage Research Society [ICRS] OCD III or IV) were treated and followed more than 18 months (18-140 with mean of 36 months). Most of the patients were young boys such as baseball players, gymnasts, boxers, and judo athletes. The elbow OCD lesions were evaluated by preoperative x-ray, computed tomography (CT), or magnetic resonance imaging (MRI), and classified into 3 types by lesion size: small (articular lesion diameter [ALD] smaller than 10 mm), medium (ALD 10-15 mm), and large (ALD larger than 15 mm). For a small lesion, it was shaved arthroscopically (AS, n = 32). For a medium lesion, it was reconstructed by a local anconeus muscle–pedicled bone graft (BG) covered with periosteum flap (n = 16). For a large lesion, it was completely shaved and reconstructed by osteochondral autograft transplantation (OAT) from the patient’s knee (n = 16) or reconstructed by cylindrical costal-rib osteochondral autograft (CCOA, n = 67). Totally, 159 patients were operated in 1998 to 2014 and 131 were enrolled in this follow-up study (follow-up rate, 82.4%). Clinical findings (pain, range of motion [ROM], and physical activity) were reviewed. Timmerman and Andrews score was evaluated before and after surgery. Results: Overall Findings—Preoperative symptoms were pain, elbow catching in their activities, and limitation of motion. Their sports activities were limited. Pain and catching were improved after surgery. ROM (flexion/extension) was 126/–14 preoperatively and improved to 134/–4 at final follow-up. More than 90% of the patients returned to their former activities. Timmerman and Andrews score was 130 preoperatively and improved to 186 at final follow-up. Each procedure showed equally good end results (ROM: preoperative and at follow-up, 125/–9 improved to 132/–4 in AS, 128/–13 improved to 135/1 in BG, 125/–11 improved to 134/–5 in OAT, and 126/–17 improved to 134/–4 in CCOA; Timmerman and Andrews: 144 improved to 185 in AS, 141 improved to 193 in BG, 134 improved to 180 in OAT, and 121 improved to 186 in CCOA). Twenty-one additional minor surgeries such as hardware removal or arthroscopic removal of free bodies were performed in 21 cases in the follow-up. Conclusions: Complete resection of the damaged articular lesion is recommended for the advanced OCD of the elbow. For a large articular lesion, several types of reconstruction were possible. This protocol will serve good functional recovery to some extent for the damaged young athletes’ elbow.
