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I'm having surgery next week for a medium-sized chunk of bone and cartilage that got knocked out of my elbow. It's an OCD injury. What are my chances for getting back into pitching for my team and how soon?

As you have probably discovered by now, OCD stands for osteochondritis dissecans. Young gymnasts and overhand athletes, particularly baseball pitchers and racket-sport players, are prone to this odd and troubling elbow condition. In the past, OCD was referred to as "Little Leaguer's" elbow. It got its name because it was so common in baseball pitchers between the ages of 12 and 20. Now it is known that other sports, primarily gymnastics and racket sports, put similar forces on the elbow. The forceful and repeated actions of these sports can strain the surface of the outer part of the elbow joint. The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It may actually break off. That's when the condition is referred to as unstable. Surgery is usually required for unstable OCD. The surgeon has several choices: the fragment can be reattached called fragment fixation. The broken piece can be removed with the remaining bone smoothed over (called debridement). Or osteochondral autograft transfer (OAT) can be done. The autograft transfer involves taking a fresh, healthy piece of bone from the patient's knee and transferring or "grafting" it into the defective area. With a small to medium-sized bone fragment, it's likely that you will be treated using the debridement approach. Studies show that debridement is able to get up to 85 per cent of competitive athletes with unstable capitellar OCD back to full sports participation. Debridement can even be used with defects that are large enough to cover more than half of the joint surface. But outcomes are usually worse with debridement in this group compared with debridement of smaller defects. If debridement is unsuccessful in reducing pain and restoring elbow function, then the next treatment option might be osteochondral autograft transfer (OAT). OAT is really used most often for those large, unstable defects that don't respond well to debridement. Fixation is another surgical method that might be used for medium to large defects. In fragment fixation, wires or bioabsorbable screws are used to hold the pieces of bone together until healing can occur. With this treatment approach, the player can get back to overhead (throwing) activities about six months after surgery. Those who have the wires used must have them removed in a second surgery. Most athletes are still able to return-to-sport even after wire removal. Outcomes reported with fixation include good resolution (or at least improvement) of pain in 85 per cent of the athletes. X-ray evidence of healing without joint degenerative changes was observed in most cases. Most athletes will require a period of rehab to regain full motion, strength, function, and coordination. Not just the elbow will require some rehab but the entire arm from shoulder to hand. About 85 per cent of patients studied with this problem who had surgery return to full participation in sports. Problems that can occur after surgical correction of OCD that keep athletes from getting back into competitive play include persistent pain and a sensation of "catching" in the joint with motion. In general, the larger the lesion, the poorer the results. And the farther out from the injury and subsequent surgery, the less favorable the outcomes reported in the studies available.

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