Retro-articular drilling and bone grafting of juvenile knee osteochondritis dissecans: a technical description

The goal of the surgery in stable juvenile osteochondritis dissecans (OCD) is to promote revascularization and reossification of the osteochondral fragment by creating channels, linking the subchondral bone to the OCD lesion. Retro-articular and trans-articular drilling of OCD lesions has up to a 33 % failure rate based on complete radiographic healing. Healing may be improved with the delivery of pluripotent mesenchymal stem cells into the lesion. We describe a technically simple procedure for retro-articular drilling with the addition of percutaneous iliac crest bone graft placement for stable juvenile OCD lesions of the knee. By using a bone marrow biopsy needle, the bone grafting can be performed in a reproducible manner and in shorter time than in previously described techniques. The proposed technique represents a promising adjunct for the management of stable juvenile OCD lesions that fail to heal after 3-6 months of non-operative treatment and for non-displaced, unstable OCD lesions that undergo internal fixation.