Retroarticular Drilling and Bone Grafting of Juvenile Osteochondritis Dissecans of the Knee

Published:February 16, 2007DOI:


      We present an effective technique for retroarticular drilling and bone grafting of juvenile osteochondritis dissecans (OCD). A radiolucent bolster is used to flex the knee at 45°, allowing adequate C-arm visualization. A 2-cm incision is made over the iliac spine, and soft tissue is dissected with the use of electrocautery. A 3.5-mm Steinmann pin is driven ∼5 cm into the iliac crest. With a mallet, the 3.5-mm-long drill sleeve from the Synthes External Fixator Set (Part #395.913; Synthes, Paoli, PA) is tamped over and 1 cm past the guide pin, while cores of autograft cancellous bone are harvested. The same Steinmann pin is inserted over the corresponding aspect of the knee. The Steinmann pin is advanced to approximately 1 cm above the lesion, and the drill guide is once again tapped over the pin. With use of the C-arm, the pin is removed, and a 3.5-mm bit is used to drill the remaining distance into the lesion. The graft is tamped through the drill guide and into position with the reverse end of the bit. This technique may be repeated according to the size of the lesion. Major advantages of this technique include the ease of harvest/transfer of autograft, readily available instrumentation to perform the procedure, and the ability to avoid violation of stable articular cartilage.

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        • Bradley J.
        • Dandyy D.J.
        Results of drilling osteochondritis dissecans before skeletal maturity.
        J Bone Joint Surg Br. 1989; 71: 642-644
        • Guhl J.F.
        Arthroscopic treatment of osteochondritis dissecans.
        Clin Orthop. 1982; 167: 65-74
        • Dipaola J.D.
        • Nelson D.W.
        • Colville M.R.
        Characterizing osteochondral lesions by magnetic resonance imaging.
        Arthroscopy. 1991; 7: 101-104
        • Cain E.L.
        • Clancy W.G.
        Treatment algorithm for osteochondral injuries of the knee.
        Clin Sports Med. 2001; 20: 321-342
        • Kocher M.S.
        • Micheli L.J.
        • Yaniv M.
        • Zurakowski D.
        • Ames A.
        • Adrignolo A.A.
        Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling.
        Am J Sports Med. 2001; 29: 562-566
      1. Chambers HG, Bruffey J, Mubarak SJ. Extraarticular drilling on osteochondritis dissecans lesions of the knee in children and adolescents. Presented at: Annual Meeting of the Pediatric Orthopedic Society of North America; May 1-4, 2000; Vancouver, British Columbia, Canada.

        • Lindholm S.
        • Pylkkanen D.
        • Osterman K.
        Fixation of osteochondral fragments in the knee joint: A clinical survey.
        Clin Orthop. 1977; 126: 256-260
        • Furukawa T.
        • Eyre D.R.
        • Koide S.
        • et al.
        Biomechanical studies on repair cartilage resurfacing experimental defects in the rabbit knee.
        J Bone Joint Surg Am. 1980; 62: 79-89
        • Wall E.J.
        • Von Stein D.
        Juvenile osteochondritis dissecans.
        Orthop Clin North Am. 2003; 34: 341-353
        • Harding W.G.D.
        Diagnosis of ostechondritis dissecans of the femoral condyles: The value of the lateral x-ray view.
        Clin Orthop. 1977; 123: 25-26