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Dr. Garcia demonstrates his technique for elbow OCD removal and microfracture for high level pitchers and gymnasts.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video demonstrates Dr. Grant H. Garcia performing an elbow arthroscopy for the removal of an osteochondritis dissecans (OCD) lesion of the capitellum, followed by a microfracture procedure. This technique is often used for high-level pitchers experiencing elbow pain and loose cartilage.
Here is a summary of the procedure shown in the video:
- Initial Evaluation & Fragment Removal: Operating in the anterior compartment, the surgeon notes that this specific patient has previous radial head damage. Utilizing a posterolateral portal and viewing from a lateral perspective, the surgeon uses a Kocher clamp to reach in and grab a large loose cartilage fragment out of the back of the joint space.
- Debridement of the OCD Lesion: A small shaver and a specialized curette are systematically synchronized to carefully remove the diseased OCD tissue from the capitellum. This meticulous step is critical to eliminating all unstable cartilage and preventing future loose bodies.
- Protecting Surrounding Anatomy: Throughout the shaving process, the surgeon ensures the instrument is always oriented toward the midline—away from the radial nerve—to prevent accidental nerve damage. Straight snaps are occasionally used to clear away smaller loose fragments.
- Preparing the Subchondral Base: The goal of the debridement is to clear the peripheral edges and expose a clean, healthy bed of subchondral bone. This solid base is required to support the next step of marrow stimulation.
- Microfracture Drilling: A soft tissue protector is inserted to prevent tissues from binding and to optimize the entry angle. A small Kirschner wire (K-wire) is then used to carefully perforate the exposed subchondral bone. This technique, known as microfracturing, triggers the marrow elements to bleed into the defect.
- Procedure Conclusion: The bleeding from the bone marrow introduces stem cells that will eventually form fibrocartilage to naturally fill and heal the defect. Dr. Garcia notes that while cartilage transplantation is a secondary option for massive defects, this microfracture technique is highly effective for relieving pain and restoring joint function in most athletes.
