• 30-degree arthroscope

• 2.7-mm arthroscope for working in direct lateral compartment

• 4.0-mm arthroscope for routine anterior and posterior compartments; inflow is from cannula of the arthroscope, and, because it is larger, it allows better inflow, joint distension, and hemostasis

• Self-locking limb positioner (eg, Arthrex Trimano, Smith & Nephew SPIDER)

• 2.9-mm full-radius shaver blade without teeth

• Microcurettes

• Allows better movement in tight lateral compartment

• Small joint obturator and cannulas

• Small slotted cannula

• 5.5-mm disposable cannula with stop cock

• Microfracture awls

• Smooth .062-in Kirschner wire

• Sterile tourniquet

• 1.6- and 2.0-mm smooth drills

• 1.6- or 2.0-mm absorbable nails for osteochondritis dissecans (OCD) fixation (1.6 mm most commonly used)

• Prone for patients under 150 lb (Fig. 21-1)

• Keeps body and table away from smaller arms

• Lateral decubitus for patients over 150 lb (Fig. 21-2)

• Self-locking limb positioner allows control of arm within tight space between elbow and table.

• Diagnostic arthroscopy is done with anteromedial, anterolateral, posterior, and posterolateral portals.

• Direct lateral and accessory lateral portals are created specifically for management of OCD lesions of capitellum.

• An inflow pump system allows better visualization while working with 2.7-mm arthroscope in the lateral compartment.

• To obtain adequate fluid pressure, pump pressure can be increased to 90-100 mm Hg to offset the small diameter of the 2.7-mm arthroscope.

• OCD fragment are identified, and the competency of the overlying cartilage is evaluated.

• Although uncommon, fragments over 1 cm in diameter and with sufficient underlying bone may be suitable for fixation.

• Small, multifragmented, and/or inadequate underlying bone should be removed.

• Typically there is loose, unstable cartilage overlying the lesion, which is easily recognized arthroscopically.

• However, lesions with intact overlying articular cartilage but unstable underlying bone require careful probing to identify soft, ballotable articular cartilage indicating location of the lesion.

• For grade I or II chondral lesions, in situ drilling with a .062-in smooth Kirschner wire should be considered.

• This is recommended for OCD fragments that are not suitable for fixation (most grade III and IV elbow OCD lesions).

• Unstable cartilage flaps are removed with a shaver and curettes (Fig. 21-3).

• The base of the OCD lesion is debrided of overlying fibrous tissue (Fig. 21-4).

• Care is taken to avoid removing excess subchondral bone.

• Loose or unstable cartilage edges that can propagate into loose bodies or chondral flaps should be removed.

• After a healthy bone base is obtained, microfracture of the capitellum is done to promote fibrocartilage healing (Fig. 21-5).