Background: Osteochondritis dissecans of the capitellum is a common condition in adolescent overhead athletes, causing pain during physical activity, limited motion range, and functional impairments. While its exact cause is not fully understood, repetitive microtrauma and reduced blood supply are thought to contribute to lesion development. Traditional surgeries for unstable OCD lesions often fail to restore cartilage or subchondral bone, potentially leading to further joint problems. Osteochondral autograft transfers have emerged as a promising alternative that aims to both restore osteochondral structure and improve sports-related outcomes. This study examines the long-term impact of OATs on capitellar OCD lesions with the hypothesis that such interventions can prevent long-term elbow disability and facilitate a return to athletic activities Hypothesis: We hypothesize osteochondral autologous transplantation surgery (OATS) provides long-term pain relief and maintains elbow function in adolescent athletes with capitellar osteochondritis dissecans (OCD) lesions. Methods: A retrospective review of patients who underwent OATS between 2009 and 2023 was performed. Patients were identified by CPT code. Clinical assessment and surgeries were performed at a single institution by a single orthopaedic surgeon. Demographic data, preoperative clinical information, radiographic assessments, intraoperative findings, and postoperative outcomes were collected. Clinical and radiographic evaluations were performed, and preoperative MRI was analyzed. Intraoperative data, including graft dimensions and histopathology, were recorded. Postoperative data included MRI, complications, range of motion, return to sports, and patient satisfaction. Results: 17 patients (15 males, 2 females) met inclusion criteria, with a mean follow-up duration of 62 months (range 12-170). The average age at time of surgery was 14 years old (±3, range 11-19). All but one patient presented with involvement of the dominant arm. All patients were athletes, with 15 competing at the elite level and 2 at the recreational level. Baseball was the most prevalent sport among these athletes. Preoperatively, every patient reported pain, and 6 of them present with a limited range of motion. The average passive pre-operative arc of motion increased from 127° ± 19 (range 80-150), with 136° of flexion and 8.9° of extension. All patients had undergone nonsurgical treatment involving rest and immobilization, and four had previously received surgical treatment at outside institutions. Intraoperatively, 4 patients had loose bodies. Synovial biopsies, performed in all cases, revealed papillary hypertrophy in 53% and mucoid/myxomatous degeneration in 59% of patients. A single osteochondral plug was used in each surgery. Postoperatively, there were no instances of instability or infections. The average passive arc of motion improved to 136.5°, consisting of 139° flexion and 3.2° extension. All athletes resumed sports activities, although one elite athlete did not return to the previous competitive level in the same sport. Additionally, one patient underwent a subsequent contracture release due to stiffness. No sign or evidence of decline in function was observed throughout the follow-up period. Summary: • This study has identified synovial inflammation as a component of this disease process. • OATS has proven to be an effective treatment for capitellar OCD in adolescent athletes. • The restoration of osteochondral architecture provides both short-term and long-term elbow pain relief and restoration of high-level function.