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Drilling techniques for osteochondritis dissecans.

Benton E Heyworth1, Eric W Edmonds2, M Lucas Murnaghan3

  • 1Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.

Clinics in Sports Medicine
|April 5, 2014
PubMed
Summary
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Most early-stage osteochondritis dissecans in young patients heal with proper management. For stable lesions unresponsive to nonoperative care, subchondral bone drilling is the gold standard treatment.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Pediatric Orthopedics

Background:

  • Osteochondritis dissecans (OCD) presents treatment challenges, particularly in advanced stages.
  • Early-stage OCD in skeletally immature patients often shows potential for healing with appropriate management.
  • Nonoperative measures like activity modification and bracing may not suffice for stable, non-healing lesions.

Purpose of the Study:

  • To review the current management of osteochondritis dissecans, focusing on subchondral bone drilling techniques.
  • To highlight drilling as a gold standard for stable OCD lesions unresponsive to conservative treatment.
  • To identify the need for comparative studies on different drilling methods.

Main Methods:

  • Review of existing literature on osteochondritis dissecans treatment.
Keywords:
DrillingKneeOsteochondritis dissecans

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  • Focus on subchondral bone drilling techniques: transarticular, retroarticular, and notch drilling.
  • Analysis of outcomes from retrospective studies on drilling efficacy.

    • Main Results:

    • Subchondral bone drilling is an effective gold standard for stable OCD lesions failing conservative treatment.
    • Various drilling techniques (transarticular, retroarticular, notch) have demonstrated effectiveness in small studies.
    • Limited high-powered prospective comparative data exists for these techniques.

    Conclusions:

    • Early-stage osteochondritis dissecans in skeletally immature patients can heal with appropriate management.
    • Subchondral bone drilling is the established treatment for stable OCD lesions not improving with nonoperative care.
    • Further prospective comparative research is necessary to determine the optimal drilling technique for OCD.