I’m looking into all the different treatments for an elbow problem I have. Basically, there is a hole in my joint cartilage down to the bone. The X-rays and MRIs show a fragment that has almost completely detached but is still hanging on by a thread. I’m young (22-years-old) and active (play recreational baseball, intramural volleyball, run, ski). I’d like to get past the pain and get my elbow motion back. So what do you recommend?

Athletes like yourself who are involved in repetitive elbow motions or overhead activities are at risk for the condition you described called osteochondral lesions. Osteochondral lesions refer to damage or defect to the joint cartilage (chondral) all the way down to the first layers of bone (osteo). Holes in the osteochondral layer and/or loose fragments of bone and cartilage in the joint can cause pain, locking of the joint, and eventually osteoarthritis.

There are many ways to treat this problem starting with conservative (nonoperative) care. When six months or more of conservative care does not yield the desired results, then surgical treatment is considered. The surgeon may remove the fragments and smooth the area over with a special surgical shaver. This procedure is called debridement.

Other surgical options include reattachment of the fragments, microfracture (drilling tiny holes to stimulate healing), or osteotomy (removing a wedge of bone to close up the hole). Sometimes these techniques don’t work as well as hoped and there is a risk of osteoarthritis later.

There is a newer approach under investigation called osteochondral autograft transfer or OAT. Osteochondral autograft transfer (OAT) involves removing a plug of cartilage and bone from a healthy area (in this case from a non-weight bearing area of the knee) and transferring it into the osteochondral lesion (i.e., hole in the surface of the same patient’s elbow joint). The word “autograft” refers to the fact that the patient donates his or her own tissue for the procedure.

Consultation with an orthopedic surgeon is advised. Smaller lesions do respond well to conservative care but yours sounds a bit more advanced than that. With your situation (attached fragment hanging by a thread), you may still be a good candidate for reattachment and rehab.

Finding out about all the different treatment choices is a good place to start. That will give you more information with which to ask the surgeon questions to help direct your choice. Your choices may be limited by the training the surgeons in your area have. Not all surgeons are trained to perform all the different techniques described here.