Were You Told Your Only Option Is to Clean Out the Elbow and Drill Holes in the Cartilage — or Take Cartilage From Your Child's Healthy Knee?
There Is Another Option.
Osteochondritis dissecans of the capitellum is a serious cartilage condition that can end a young athlete's career. It does not have to.
Dr. Raffy Mirzayan was the first surgeon in the world to use fresh osteochondral allograft transplantation to treat OCD of the capitellum, beginning in 2006. He has since published the largest single-surgeon series in the medical literature on this condition — with outcomes that no other technique has matched — and has presented his experience on the Arthrex global surgical education platform. His results: 100% graft incorporation. 100% of overhead athletes returned to sport at the same level or higher. Two patients went on to pitch professionally.
If your child is a baseball player or gymnast who has been told to "clean out" the elbow, undergo microfracture drilling, or have cartilage harvested from their own knee — read this carefully before making any decision.
To schedule a consultation, call (310) 746-5918. Virtual consultations are available for families traveling from out of state.
What Is OCD of the Capitellum?
The capitellum is the rounded end of the humerus — the part of the upper arm bone that forms the elbow joint with the radial head. In young overhead athletes, particularly baseball pitchers and gymnasts, repetitive loading of this joint can disrupt the blood supply to a focal area of bone just beneath the cartilage surface. That bone softens, fragments, and eventually collapses — leaving a painful defect on the joint surface of the elbow.
The typical patient Dr. Mirzayan sees is a 14- or 15-year-old male baseball pitcher, or a slightly younger gymnast. These athletes present with gradually worsening elbow pain, inability to perform their sport, stiffness, and sometimes locking or catching if a loose fragment has broken free into the joint. Most have been symptomatic for months — sometimes more than a year — before reaching a surgeon with the expertise to treat this condition definitively.
Why Most Treatments Fail
The majority of surgeons who treat OCD of the capitellum perform arthroscopic debridement — a "clean-out" of the joint — sometimes combined with microfracture. Microfracture involves drilling small holes into the cartilage defect to stimulate a healing response. The fundamental problem with this approach is that microfracture does not restore the right kind of cartilage. It produces fibrocartilage — a scar-tissue substitute that is structurally inferior to the native hyaline articular cartilage that lines the joint. Fibrocartilage cannot withstand the high compressive and rotational forces placed on the elbow during overhead throwing. It degrades.
This is so well established in the knee literature that most sports medicine surgeons have abandoned microfracture for knee cartilage defects entirely. The capitellum is no different.
When the microfracture and debridement studies are read carefully, the return-to-sport rates look acceptable on the surface — but athletes return for only a few months before stopping. The literature reports return-to-sport rates of 64% to 71% after debridement or microfracture, and many of those athletes do not sustain that return.
Some surgeons recognized this and began harvesting cartilage from the patient's own knee to reconstruct the capitellum — a technique called osteochondral autograft transfer. This does restore hyaline cartilage, but at a significant cost: up to 20% of patients develop persistent knee pain from the donor site. For a young athlete who needs both joints to be healthy, that is an unacceptable trade-off.
Dr. Mirzayan's Approach: Fresh Osteochondral Allograft Transplantation
In 2006, Dr. Mirzayan became the first surgeon in the world to use fresh osteochondral allograft transplantation for OCD of the capitellum. Rather than harvesting cartilage from the patient's knee, he uses a fresh donor femoral hemicondyle — tissue that provides an abundant supply of living hyaline cartilage matched to the curvature of the capitellum. The damaged cartilage and bone are removed, and one or two cylindrical allograft plugs are press-fit into the defect, restoring a smooth, durable joint surface with real hyaline articular cartilage.
No donor site. No knee surgery. No fibrocartilage.
The procedure begins with a diagnostic arthroscopy to confirm the lesion, remove any loose bodies, and address associated stiffness. Dr. Mirzayan then performs the transplantation through a small 3-centimeter incision using a ligament-sparing approach that avoids disrupting the elbow's stabilizing structures — allowing for faster, more aggressive rehabilitation from the outset.
For larger lesions, two plugs are placed side by side in what Dr. Mirzayan calls the "Mastercard technique." This is possible precisely because the donor hemicondyle provides more graft material than any autograft harvest from the patient's knee could offer. More than one-third of patients in his published series required two plugs — a scenario that would be technically limiting or impossible with autograft.
Dr. Mirzayan presented his full experience with this technique in a comprehensive surgical education presentation produced by Arthrex: Treatment of Capitellar Osteochondritis Dissecans Using Precut Fresh Osteochondral Allografts
The Results- Published Evidence
Dr. Mirzayan's outcomes have been published across three peer-reviewed studies spanning nearly two decades of experience — the most comprehensive published record on this procedure by any single surgeon in the world.
His first publication described the technique in detail, appearing in Techniques in Shoulder and Elbow Surgery in 2016 — the first report in the surgical literature of fresh osteochondral allograft transplantation being used to treat OCD of the capitellum: Fresh Osteochondral Allograft Transplantation for OCD of the Capitellum — Techniques in Shoulder and Elbow Surgery (2016)
His second publication reported outcomes on an initial cohort of patients, establishing the first clinical evidence base for this technique and confirming meaningful, durable improvement across functional outcome measures: First outcomes series — fresh osteochondral allograft for OCD of the capitellum
His landmark 2024 paper in the American Journal of Sports Medicine — one of the most prestigious journals in orthopedic surgery — reported outcomes on 35 patients with a mean follow-up of nearly 8 years, with some patients followed for up to 17 years. This is the largest single-surgeon series ever published on this condition and represents the definitive clinical evidence for this procedure: AJSM 2024 — Largest published series of fresh osteochondral allograft transplantation for OCD of the capitellum
The results from that study:
100% graft incorporation on postoperative MRI — no graft failures, no rejections. 100% of overhead athletes returned to their sport and performed at the same level or higher for more than two years. KJOC scores — the most sensitive validated outcome measure for overhead throwing athletes — improved from 40.8 to 90.6, a statistically significant, clinically meaningful result. Pain scores dropped from 7.5 out of 10 preoperatively to 0.3 out of 10 at final follow-up. Two patients went on to pitch professionally, reaching top velocities of 94 and 96 mph. One patient earned a Division I NCAA baseball scholarship. One patient earned a Division I NCAA tennis scholarship. No major complications. No graft rejections. Outcomes sustained over nearly a decade of follow-up with no deterioration over time. For comparison: microfracture and debridement studies report return-to-sport rates of 64% to 71%, with athletes frequently unable to sustain that return more than a few months. Dr. Mirzayan's series: 100% return to overhead sports for a minimum of 2 years. Dr. Mirzayan's work on this procedure was also featured at the American Academy of Orthopaedic Surgeons 2025 Annual Meeting — one of the most prominent forums in orthopedic surgery — further establishing this technique as a subject of national academic interest: AAOS 2025 — Fresh Osteochondral Allograft for OCD of the Capitellum
Recovery and Return to Throwing
This is an outpatient procedure. Patients go home the same day.
During the first ten days, the elbow is protected in a splint. At two weeks, the splint is removed and physical therapy begins with a focus on regaining full pain-free motion. By one month, the goal is full range of motion. From months one through three, progressive strengthening is the focus with no throwing or push-up loading. A structured interval throwing program begins at three to four months. Most pitchers are cleared to return to full throwing between four and a half and five months. Non-throwing athletes — gymnasts, tennis players — are typically cleared at four to five months.
Coming from Las Vegas, Phoenix, Texas, Florida, or Out of State?
Baseball is a national sport. OCD of the capitellum is rare, and very few surgeons have the experience and published outcomes that Dr. Mirzayan brings to this procedure. He regularly sees families traveling from across the country — particularly from states where baseball is played year-round and these injuries occur at the highest rates: Texas, Florida, Arizona, Georgia, Nevada, and the Carolinas.
The travel ball and showcase circuit — Perfect Game, USSSA, and similar events — means families are already accustomed to traveling for baseball. Traveling for the right surgeon is no different. A family from Dallas or Tampa should not settle for a local surgeon who has performed this procedure a handful of times when the world's most experienced surgeon for this specific condition is a flight away.
Dr. Mirzayan is an out-of-network surgeon, but many patients with commercial insurance — Blue Cross Blue Shield PPO, Aetna, Cigna, United Healthcare, and self-funded employer plans — have strong out-of-network benefits that result in minimal out-of-pocket costs, often equivalent to or less than what they would pay seeing an in-network surgeon locally. His office will guide your family through the insurance verification process before you commit to anything.
Virtual consultations are available. You can meet Dr. Mirzayan on video, review your child's imaging together, and determine whether making the trip to Los Angeles is the right next step — before booking a flight or taking time away from school and work.
Call (310) 746-5918 or contact us online to schedule your consultation.
Frequently Asked Questions
What causes OCD of the capitellum?
Repetitive loading of the elbow during overhead throwing or gymnastics disrupts the blood supply to a focal area of bone beneath the cartilage on the capitellum. This leads to softening, fragmentation, and progressive cartilage loss. It is most commonly seen in young male baseball pitchers and female gymnasts between the ages of 12 and 17.
At what point does a young athlete need surgery?
Stable lesions in skeletally immature athletes with open growth plates are initially managed nonoperatively with rest and activity modification. Unstable lesions — where the cartilage is partially or completely detached — require surgical reconstruction. Nearly all patients Dr. Mirzayan sees have already completed a prolonged course of rest and nonoperative treatment without adequate improvement.
Why not just do a clean-out?
Debridement may reduce pain temporarily, but it does not restore the joint surface. Studies show that 54% to 60% of athletes are unable to return to their previous level of sport after debridement alone, and the cartilage defect continues to progress over time. Restoring the actual articular surface with living hyaline cartilage produces dramatically better and more durable results.
Why not use cartilage from the patient's own knee?
Knee autograft restores hyaline cartilage but up to 20% of patients develop persistent knee pain from the harvest site — a serious complication for a young athlete who needs both joints to be healthy. Fresh allograft achieves the same cartilage restoration without any donor site risk, and provides more graft material, making it possible to treat larger lesions that autograft cannot adequately address.
Is there a risk of rejection with donor cartilage?
No. In Dr. Mirzayan's entire published series — 35 patients with up to 17 years of follow-up — there were no graft rejections and no graft failures. Osteochondral allografts are immunologically privileged tissue. The chondrocytes within the cartilage matrix are protected from immune recognition, which is why rejection is not a concern with this technique.
What if the lesion is large and requires two plugs?
For larger or laterally based lesions, Dr. Mirzayan uses the "Mastercard technique" — placing two plugs side by side to achieve complete coverage of the defect. More than one-third of patients in his published series required this approach. The donor hemicondyle provides ample graft material without the size constraints that would limit an autograft harvest from the patient's own knee.
My child wants to play college or professional baseball. Is that realistic after this surgery?
Based on Dr. Mirzayan's published outcomes — followed for up to 17 years — yes. Multiple patients in his series went on to pitch at the collegiate level on full Division I scholarships. Two patients played professional baseball, pitching at velocities of 94 and 96 mph. These are not anecdotes. They are part of a peer-reviewed, published dataset reported in the American Journal of Sports Medicine.
Can I see the surgical technique before deciding?
Yes. Dr. Mirzayan produced a comprehensive surgical education presentation on this procedure with Arthrex, available on their global platform used by orthopedic surgeons worldwide: Arthrex Presentation — Fresh Osteochondral Allograft for OCD of the Capitellum. Dr. Mirzayan encourages informed patients and families.
Do you see patients from outside Los Angeles?
Yes. Dr. Mirzayan regularly treats patients from Las Vegas, Henderson, Phoenix, Scottsdale, Texas, Florida, Georgia, and across the country. Virtual consultations are available. For a young pitcher or gymnast with OCD of the capitellum, a consultation with Dr. Mirzayan — in person or by video — is often the fastest path to the right treatment and the best possible outcome. Call (310) 746-5918.
Is this covered by insurance?
Osteochondral allograft transplantation is typically a covered procedure under commercial insurance. Dr. Mirzayan is an out-of-network surgeon, but many patients with PPO plans or self-funded employer plans have strong out-of-network benefits — in some cases equivalent to in-network coverage. His team will verify your benefits before your consultation so your family has a clear picture of costs before making any decisions.
About Dr. Raffy Mirzayan
Dr. Raffy Mirzayan, MD is a double-board certified orthopedic sports medicine surgeon, the world's first surgeon to use fresh osteochondral allograft transplantation for OCD of the capitellum, and the author of the largest published single-surgeon series on this procedure in the medical literature. He began performing this technique in 2006 — nearly two decades before most surgeons had heard of it — and has followed his patients for up to 17 years with results that no other technique has matched. With more than 350 cartilage transplantation procedures performed, more than 1,000 elbow arthroscopies, and 88 peer-reviewed publications including landmark studies in the American Journal of Sports Medicine, Dr. Mirzayan brings a depth of experience to this specific condition that simply does not exist anywhere else. He practices at DOCS Health in Los Angeles, serves as a Clinical Professor of Orthopaedic Surgery at USC, and welcomes patients from across the United States — including Las Vegas, Phoenix, Texas, and Florida — for virtual consultations and in-person care.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 | (310) 746-5918 | raffymirzayan.com
