This chapter presents a clinical scenario of a 14-year-old with posterior lateral elbow pain for over one year. The pain is sharp during loading of the elbow with throwing, and with axial loading with the elbow in extension. Plain radiographs show radiolucency in the capitellum and magnetic resonance imaging shows a 1 × 1.2 cm capitellar osteochondral defect. Nonoperative management is considered the first step in the treatment of patients with a clinically and radiographically stable osteochondritis dissecans (OCD) lesion of the humeral capitellum; however, studies suggest differences in outcomes and healing related to skeletal maturity of the capitellum. There have been several surgical treatments (i.e. fixation, debridement) described for unstable OCD lesions in the elbow. Debridement of the defect has shown good short-term results. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.