Drilling Techniques for Osteochondritis Dissecans

Key points

Transarticular drilling

The technique of transarticular drilling begins with arthroscopic assessment of the OCD lesion, which includes both direct visualization of the appearance of the lesion, and palpation of the margins of the lesion and the surrounding cartilage with an arthroscopic probe. If significant disruption of the contour of the articular cartilage is present, or if gross mobility of the lesion or significant chondral fissuring is seen, consideration of the addition of fixation of the lesion should be

Retroarticular drilling

Arthroscopic assessment of the OCD lesion before retroarticular drilling is performed in similar fashion to that described for transarticular drilling. After confirmation of lesion stability, the arthroscopy equipment is removed from the joint and a C-arm fluoroscopy unit is set up for an anteroposterior view of the knee (Fig. 2A). A 0.062- or 0.045-inch K-wire is placed percutaneously through the cortex of the affected condyle, just distal to the distal femoral physis, and advanced so that the

Notch drilling

Drilling through the intercondylar notch follows the same general surgical principles as the 2 techniques described earlier, starting with an arthroscopic assessment of the OCD lesion. Kawasaki and colleagues¹¹ describe introducing a 1.5-mm K-wire through the anteromedial or anterolateral portal for drilling of a lateral or medial femoral condyle OCD lesion, respectively. The wire is advanced into the “bare area” of the intercondylar space, just behind the lesion, with “more than three K-wires”

Authors’ preferred technique

Both the transarticular and retroarticular techniques, as described earlier, are safe and effective, and are interchangeably used for OCD lesions in various locations of the knee. Transarticular drilling is often preferred, because it allows reliable visualization of entry of the K-wire directly into the lesion, with a desired coverage and spacing of drilling passes. For obviously stable lesions, which are seen clearly on plain radiographs but with margins that may not be clearly identifiable

Summary

Drilling of OCD, when pursued for skeletally immature patients with stable OCD lesions that do not demonstrate healing with conservative measures, is highly effective at stimulating radiographic healing of the affected subchondral bone and allowing for a good return to function and sports activities. Several techniques with subtle variations have been described, with each having its own theoretical advantages, but few reports have provided clear guidelines that dictate the pathways of an