Osteochondritis dissecans of the capitellum represents a challenging clinical entity. For lesions that are unstable, cause mechanical symptoms, or fail conservative management, surgical intervention may be considered. Prior reports have described debridement, microfracture, retrograde drilling, osteochondral autologous transplantation surgery, distal humeral realignment osteotomy, and direct repair with pins or osteochondral pegs. For well-attached lesions without significant fragmentation, fixation may be achieved using a simple direct suture repair technique. This method involves passage of a mattress-type suture through the lesion that is tied over the posterior cortex. No specialized instruments or implants are required. To date, no patients treated in this manner have been reoperated.