Loose Body, Plica, and Osteochondritis Dissecans

Osteochondritis dissecans (OCD) lesions of the elbow are common in young athletes actively involved in overhead throwing activities. They tend to occur on the capitellum and are often associated with loose bodies and radiocapitellar plicae that can cause painful clicking and locking symptoms. A magnetic resonance imaging is useful to assess the stability of the OCD lesion as well as identify cartilagenous and fibrous loose bodies. The optimal management of elbow OCD remains unknown. Stable lesions can be managed with rest and sports restriction. When this has failed or with unstable lesions, elbow arthroscopy has become a safe and effective therapeutic tool. The surgeon must have a detailed three-dimensional knowledge of the complex anatomy of the elbow, create precise portals, and use fluid management and retractors judiciously. On the basis of the current report, arthroscopic loose body removal, plica excision, and microfracture technique of the remaining base of the OCD lesion has the most predictable functional outcome. Unstable OCD lesions with associated loose bodies that are left untreated predictably lead to elbow arthritis in the long term.

Keywords: osteochondritis dissecans, elbow arthroscopy, loose bodies, plica