Lateral osseous bridging as a practical radiographic milestone for early return to pitching in adolescent baseball players with stable capitellar osteochondritis dissecans

Background: Capitellar osteochondritis dissecans (OCD) involving the lateral column may require prolonged rest until complete radiographic healing.This study evaluated the outcomes of a conservative strategy permitting return to pitching (RTP) after radiographic lateral osseous bridging in adolescent baseball players with stable capitellar OCD.Methods: Twenty-three adolescent baseball players (mean age, 12.7 years; pitcher:fielder = 8:15) with stable lateral column capitellar OCD treated between 2017 and 2024 were retrospectively reviewed.Lateral osseous bridging was defined as a continuous osseous rim across the lateral capitellar margin without an intervening radiolucent cleft.Outcomes assessed included lesion characteristics, treatment compliance, RTP timing, healing, pain, and subsequent surgery.Results: Six patients presented with localized lateral lesions and 17 with extended lateral lesions.The mean initial lesion width was 10.6 mm (52.1% of the radial head width [RHW]).All players continued baseball during the mean follow-up of 24.8 ± 16.8 months.The mean time to RTP was 4.3 ± 1.4 months.Fifteen patients (65.2%) demonstrated complete radiographic healing at 7.3 ± 3.9 months (localized, 3.8 ± 0.8; extended, 9.6 ± 3.5 months).At RTP, the mean residual lesion width was 7.4 ± 3.5 mm (36.4% ± 15.5% of RHW).Eight patients experienced incomplete central healing; five remained asymptomatic, whereas three (13.0%)developed motion-related pain and underwent arthroscopic fragment excision and microfracture.On univariate analysis, larger initial lesion size (P = 0.026) and poor compliance (P = 0.026) were associated with incomplete healing.Conclusion: This study revealed that early RTP after lateral osseous bridging was feasible at a mean of 4.3 months.However, lateral osseous bridging should be regarded as a practical radiographic milestone rather than as a substitute for complete central healing.Continued follow-up is recommended, as some players subsequently required surgery.