The objective of the treatment for osteochondritis dissecans of the humeral capitulum is to prevent the occurrence of osteoarthritis and to allow the patients to return to throwing activities. In repairing osteochondral defects in advanced osteochondritis dissecans of the humeral capitulum after free body removal, we have performed block-shaped costal osteochondral grafting in 18 elbows since 1997. A block-shaped graft harvested from the transitional area between the rib and its associated cartilage was implanted to the osteochondral defect. This method allows the osteochondral defect to be repaired with uniform hyaline cartilaginous articular surface without any effect to other joints. Donor site no longer causes pain at 2 or 3 days after surgery. The purpose of this study is to describe the history, indications, and the surgical techniques of costal osteochondral grafting for advanced osteochondritis dissecans of the capitulum.