Osteochondritis Dissecans (OCD) Capitellar Repair Protocol

Osteochondritis dissecans (OCD) of the capitellum is a joint disorder where a segment of bone and its overlying articular cartilage in the elbow’s lateral column become damaged. Surgical repair aims to stabilize or restore the joint surface (via internal fixation, microfracture, or osteochondral autograft transplantation). Rehabilitation must carefully balance joint protection—specifically minimizing shear and compression forces on the lateral elbow—with the gradual restoration of range of motion (ROM) and muscle strength. This protocol outline is designed to support a safe, structured return to athletic and daily activities.

Phase I: Protection and Joint Recovery (Weeks 0-4)

The primary goals of this initial phase are to protect the repair/fixation site, manage post-operative pain and swelling, and initiate gentle range-of-motion exercises within a safe arc.

• Goals:
  • Protect the surgical repair or graft site.
  • Control pain and swelling (edema).
  • Achieve controlled range of motion: Elbow extension/flexion within allowed brace limits.
  • Minimize muscle atrophy of the forearm and shoulder girdle.
• Precautions & Restrictions:
  • Keep the elbow in a hinged brace, locked at 90° for the first 1-2 weeks except for controlled exercises.
  • Strictly no weight-bearing (non-weight-bearing) on the operated arm.
  • Avoid passive elbow extensions or forceful terminal elbow extension.
  • No resistive forearm pronation or supination.
• Suggested Exercises:
  • Active and passive range of motion of the wrist, hand, fingers, and shoulder.
  • Elbow ROM (flexion/extension) as tolerated in the hinged brace (typically restricted from 30° to 100° in week 2, progressing to 15° to 120° by week 4).
  • Gentle active-assisted supination and pronation with elbow flexed at 90°.
  • Submaximal isometric elbow flexion and extension (avoid pain or shear).
• Criteria to Progress:
  • Surgical incisions are fully healed.
  • Minimal pain and swelling.
  • Elbow ROM from 15° to 120° (or as directed by the surgeon).

Phase II: ROM Restoration & Early Strengthening (Weeks 4-8)

This phase focuses on weaning off the brace, achieving full passive and active range of motion, and starting light, non-weight-bearing strengthening exercises.

• Goals:
  • Restore full, painless active and passive elbow range of motion (extension, flexion, pronation, supination).
  • Wean from the hinged elbow brace (typically discontinued by week 6).
  • Establish normal scapular and rotator cuff activation.
  • Initiate light, progressive forearm and elbow strengthening.
• Precautions & Restrictions:
  • No weight-bearing exercises (no push-ups, planks, or closed-chain loading).
  • Avoid lifting anything heavier than 2-3 pounds.
  • Avoid sudden, jerky elbow extensions or valgus stress.
• Suggested Exercises:
  • Active-assisted and active elbow ROM to achieve full extension and flexion.
  • Gentle stretching of forearm flexors, extensors, pronators, and supinators.
  • Scapular strengthening (rows, Ys/Ts, scapular clocks) and rotator cuff isometrics/light band exercises.
  • Light elbow flexion/extension curls using 1-2 lb weights or very light resistance bands.
• Criteria to Progress:
  • Full active elbow range of motion in all planes without pain.
  • No tenderness or swelling at the lateral elbow.
  • Adequate scapular control and baseline shoulder strength.

Phase III: Progressive Strengthening & Joint Loading (Weeks 8-12)

With cartilage healing progressing, this phase introduces more challenging resistance exercises, progressive lateral column loading, and initial dynamic training.

• Goals:
  • Maintain full, pain-free range of motion.
  • Progressively build elbow flexion, extension, pronation, and supination strength.
  • Improve dynamic stability of the shoulder, scapula, and core.
  • Gradually introduce light, controlled joint loading.
• Precautions & Restrictions:
  • No heavy weight-bearing (e.g., standard push-ups or bench press).
  • Avoid sudden impact or high-velocity overhead throwing.
  • Exercises must remain strictly pain-free.
• Suggested Exercises:
  • Progression of biceps curls, triceps press-downs, and forearm wrist exercises.
  • Shoulder and scapular strengthening (including "Thrower’s Ten" program elements).
  • Closed-chain exercises starting on a wall (wall slides, wall push-ups) to introduce light loading.
  • Core and lower body cardiovascular conditioning.
• Criteria to Progress:
  • Full, pain-free elbow range of motion.
  • Forearm and elbow strength at least 70-80% of the uninjured side.
  • Ability to perform light closed-chain loading on a wall without pain or catching.

Phase IV: Advanced Loading, Sport-Specific Drills & Return to Play (Weeks 12-24)

The final phase focuses on heavy joint loading, plyometrics, sport-specific movements (e.g., throwing, gymnastics), and achieving full clearance for a safe return to competitive play.

• Goals:
  • Restore full muscular strength, power, and endurance.
  • Perform full weight-bearing closed-chain exercises without symptoms.
  • Safely transition to sport-specific activities (throwing program, gymnastics, racquet sports).
  • Achieve clinical and radiographic clearance for unrestricted return to play.
• Precautions & Restrictions:
  • Avoid returning to contact sports or high-impact gymnastics/weightlifting without explicit surgeon clearance.
  • Do not push through joint pain, clicking, or swelling.
• Suggested Exercises:
  • Advanced strength training (bench press, push-ups, pull-ups) progressed gradually as tolerated.
  • Plyometric exercises (medicine ball chest passes, overhead tosses, wall dribbles).
  • Interval Throwing Program (ITP) for overhead athletes (usually starting around 16 weeks, if radiographic healing is confirmed).
  • Sport-specific drills (racquet swings, gymnastics support progressions).
• Criteria for Return to Sport:
  • Full, pain-free elbow range of motion.
  • Elbow and shoulder strength at least 90% of the uninjured limb.
  • Successful completion of an interval throwing or sport-specific progression.
  • Radiographic evidence of complete osteochondral healing (confirmed by surgeon).

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.