Elbow pain is a serious concern for baseball players, especially pitchers. When 17-year-old Aurora resident Nathan Tassos began experiencing pain and difficulty pitching during fall 2021, he sought guidance from Zahab Ahsan, M.D., an orthopedic surgeon and sports medicine specialist with Edward-Elmhurst Medical Group.

An initial course of physical therapy got Nathan back on the field, but within a few months, he returned with more pain and decreased range of motion. An MRI allowed Dr. Ahsan to diagnose osteochondritis dissecans (OCD), or damage to the cartilage and bone in the elbow.

“OCD is like a pothole in the elbow,” says Dr. Ahsan. “Increased force on the elbow common in overhead throwing athletes, such as pitchers, leads to repetitive stress and a loss of blood supply in which an area of bone and cartilage becomes nonviable.”

Due to the large size of the affected area in Nathan’s elbow, about one centimeter in diameter, he and his mom, Melanie, were presented with two options: Nathan could give up pitching or move forward with a cartilage transplant.

The transplant surgery would involve taking a similar size of cartilage and bone from Nathan’s knee and using it to fill the defect in his elbow. An avid ball player since the age of 5, Nathan was ready for the surgery, but his mom was hesitant.

“At first, I said “no” and wanted to wait and see,” Melanie says. “And Dr. Ahsan didn’t pressure us at all, he was super supportive.” Shortly before the surgery, Melanie had a resurgence of her fears. “From a parent perspective, Dr. Ahsan made me feel so comfortable and took the time to make sure we were well informed. I knew Nathan would be well taken care of.”

“I wanted the surgery from the start,” adds Nathan. “He made it really easy; I knew exactly what was going on the whole time.”

The surgery, which took place in May 2022, is one of the more complex procedures done in the realm of orthopedics. Dr. Ahsan partnered with Edward-Elmhurst Medical Group hand and upper extremity orthopedic surgeon, Kushal Patel, M.D., and the two worked simultaneously on Nathan’s elbow and knee.

The collaboration between the two surgeons is something they both value. “The operation we did on Nathan is not something that most people are comfortable with or have experience with,” says Dr. Patel.

“We both have slightly different training backgrounds and complimentary skillsets, which benefits our patients.” Working together allows the surgery to be completed in a more expedited fashion and for patients to have the benefit of two surgeons in the room, which is very valuable for complex decision-making during the procedure.

After the damaged area of the bone and cartilage in the elbow is exposed, it is prepared to receive the transplant with a sharp blade and reamer. Then, an identical-sized amount of tissue is taken from a non-weight-bearing portion of the knee and carefully placed into the elbow defect with a press-fit technique. The donor area within the knee is replaced with cadaver bone and cartilage.

“The overarching theme here is numbers in millimeters,” says Dr. Ahsan. “We must get the measurements perfect.” The elbow is a small, intricate joint and for normal range of motion, the smooth surface of the cartilage must be perfectly aligned.

From start to finish, the outpatient surgery took about three hours. Nathan went home the same day and began physical therapy the next day to ensure early range of motion was achieved.

From Nathan’s perspective, the surgery was a breeze. “The procedure was really easy for me, I went to school the next day and felt fine,” he says. “My knee hurt the most in the first few days, but that was it.”

Dr. Ahsan describes three stages of physical therapy that were part of Nathan’s recovery: about 4-6 weeks of range of motion work, another 4-6 weeks of strengthening and then finally, three months following a specific return to throwing protocol.

Now a senior in high school, Nathan is preparing for his final season as a pitcher which kicks off in March and says he’s been feeling 100% since September. He’s glad he had the surgery and Dr. Ahsan and Dr. Patel are equally glad to have been a part of his experience.

“For myself, these are the types of things that make all the years of medical education and surgical training worthwhile,” says Dr. Ahsan. “Nathan was so motivated, and I am grateful to have been involved in his care and to have the collaboration of Dr. Patel.”

“You know, it’s really satisfying to see someone go back to the thing they enjoy doing,” agrees Dr. Patel. “It’s so rewarding to be a part of that.”

The orthopedic team of experts at Edward-Elmhurst Medical Groups-Orthopedics provides exceptional orthopedic, sports medicine and podiatry services for patients of all ages. We use the least invasive treatments necessary to help you get back to the activities you enjoy, as quickly as possible. Learn more.