Return to Sport After Surgical Treatment of Capitellar Osteochondritis Dissecans Lesions in Baseball Players: A Systematic Review and Meta-analysis

Background: Because of the difficulty of baseball players with capitellar osteochondritis dissecans (OCD) lesions to return to sport (RTS), multiple operative strategies have been used for these lesions. However, there has yet to be a systematic review of RTS outcomes in specifically baseball players. Purpose/Hypothesis: The purpose of this study was to compare the RTS rates between surgical procedures for capitellar OCD lesions in youth baseball players, with a secondary purpose of comparing improvements in elbow range of motion (ROM) and improvements in Timmerman-Andrews scores between surgical procedures. The authors hypothesized that RTS rates would not differ based on the surgical procedure for capitellar OCD lesions in youth baseball players. Study Design: Systematic review; Level of evidence, 4. Methods: The authors performed a literature search in February 2025 to identify studies evaluating postoperative outcomes for the treatment of capitellar OCD lesions in youth baseball players. Surgical procedures were grouped into debridement/loose-body removal ± microfracture, fixation procedures, bone peg grafting, and autologous osteochondral transplantation. Preoperative and postoperative elbow flexion and extension ROM, Timmerman-Andrews scores, and RTS rate and time were collected. Meta-analysis included pooled effect estimates for improvements in flexion ROM, extension ROM, and Timmerman-Andrews scores, as well as the proportion of RTS, applying a common effect model. Results: Overall, 462 studies were screened and 16 studies were included. There were 389 total youth baseball players and 89% of lesions were unstable. RTS after autologous osteochondral transplantation (175/182; 96%) was more likely than after fixation (68/76; 89%), bone peg grafting (27/31; 87%), or debridement/loose-body removal ± microfracture (59/70; 84%) ( P = .022). Overall, 31 of 60 (52%) pitchers were able to return to pitching. Fixation procedures were associated with greater improvements in elbow extension ROM (8° vs 3°; P = .013) than autologous osteochondral transplantation. Fixation procedures (score, 71) and autologous osteochondral transplantation (score, 58) also had greater improvements in Timmerman-Andrews scores than bone peg grafting (score, 26; P < .001); however, there was significant heterogeneity across studies and large differences in preoperative Timmerman-Andrews scores across groups. Conclusion: Overall, 92% of youth baseball players RTS after operative management of capitellar OCD lesions, with the highest RTS rates after autologous osteochondral transplantation; however, almost half of pitchers are unable to return to pitching. Clinicians can counsel injured youth baseball players that capitellar OCD lesions indicated for autologous osteochondral transplantation can have similar or better RTS outcomes than OCD lesions indicated for fixation or debridement ± microfracture.