Early studies on nonoperative management of elbow OCD lesions reported generally poor outcomes.¹–³ Takahara et al. reported 50% of patients had residual symptoms in their elbow with daily activity and displayed radiographic evidence of degenerative changes, and no patients returned to previous sport.² In subsequent studies, outcomes with nonoperative treatment have been stratified by radiographic and clinical findings at presentation.⁴,⁵ Takahara et al. and Mihara et al. characterized a lesion as “stable” if patients had an open capitellar physis, flattening or radiolucency of the subchondral bone, and normal elbow range of motion.⁴,⁵ A radiographically “early” defect was considered grade I (localized flattening or radiolucency without sclerosis) or grade II (nondisplaced fragment with sclerosis). A radiographically “advanced” defect showed grade III (displaced or detached fragment) changes.⁴,⁵ Early stable lesions in skeletally immature patients often heal with nonoperative management;⁴,⁵ therefore, a trial of nonoperative management was indicated in these patients. Nonoperative treatment typically included activity restriction, a brief period of immobilization, oral nonsteroidal anti‐inflammatory drugs (NSAIDs), and physical therapy exercises.⁴–⁶ Currently, no universal guidelines exist on duration of nonoperative treatment, but rather it is guided by symptoms. Generally, it involves six weeks of strict rest from activities that cause pain, with a gradual return to activity and sport over a three‐ to six‐month period.⁶,⁷

While patients with early stable lesions often healed with rest alone, more advanced defects and defects in patients with a closed capitellar physis are at higher risk of failure with nonsurgical treatment.⁴,⁵ In general, patients with a closed physis typically have more advanced OCD lesions at presentation.⁵ Mihara et al. reported significantly higher healing rates after nonoperative management in patients with early‐stage OCD lesions and an open physis when compared to patients with a more advanced OCD and a closed physis. They were unable to demonstrate a statistical difference in healing rates between early‐stage OCD lesions between patients with open versus closed physes, but the number of patients was small.⁵ In other reports, the healing rate with nonoperative management in patients with closed growth plates and unstable, advanced lesions has been low.³,⁵,⁶,⁸,⁹ Therefore, patients with an open capitellar physis and stable OCD lesions have greater healing potential with nonoperative management than patients with advanced OCD lesions with a closed physis.