Arthroscopic Microfracture for Osteochondritis Dissecans Lesions of the Capitellum  Christopher L. Camp, M.D., Joshua S. Dines, M.D., Ryan M. Degen, M.D., Alec L. Sinatro, B.A., David W. Altchek, M.D.  Arthroscopy Techniques  Volume 5, Issue 3, Pages e477-e481 (June 2016) DOI: 10.1016/j.eats.2016.01.030 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Coronal and sagittal magnetic resonance imaging of an osteochondritis dissecans lesion of the capitellum (arrows) in a right elbow. In this instance, high signal intensity behind the osteochondritis dissecans lesion is suggestive of partial or complete delamination of the fragment. It is critical that stability of the fragment is assessed at the time of surgery. Arthroscopy Techniques 2016 5, e477-e481DOI: (10.1016/j.eats.2016.01.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 The patient is placed in the supine position with the right arm in an arm holder across the chest. (A) Key bony landmarks are used to help localize the necessary portals on the lateral aspect of the elbow. To fully access the osteochondritis dissecans defect, the elbow is flexed and a 70° arthroscope is inserted through the posterolateral portal (PLP). (B) The direct posterolateral portal (DPLP) is centered over the lesion and is used as a working portal. (LE, lateral epicondyle; Olec, olecranon; PALP, proximal anterolateral portal; RH, radial head.) Arthroscopy Techniques 2016 5, e477-e481DOI: (10.1016/j.eats.2016.01.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) With the patient in the supine position and the right arm across the chest, the radiocapitellar joint can easily be identified when viewing anteriorly from the proximal anterolateral portal. In this position, however, it is difficult to view the lesion in its entirety. (B) Flexing the elbow and placing the camera in the posterolateral portal allow better visualization of the osteochondritis dissecans (OCD) lesion, especially if a 70° arthroscope is used. (C) In this case the lateral shoulder of the capitellum remains intact after debridement. (D) Accordingly, arthroscopic microfracture can be performed. (RH, radial head.) Arthroscopy Techniques 2016 5, e477-e481DOI: (10.1016/j.eats.2016.01.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions