All-Arthroscopic Suture Fixation of Patellar Osteochondritis Dissecans

Osteochondritis dissecans of the knee, despite its cause, is characterized by the impairment of the subchondral bone. Failure of its spontaneous healing makes surgical fixation often necessary. The patella is less affected than other locations in the knee. Its surgical treatment remains a challenge due to the thickness of the lesion and the complex approach of the retropatellar cartilage. Arthroscopy has the theoretical advantage to avoid a possible arthrotomy; however, the retrograde application of fixation materials does not guarantee good fragment compression and may lead to cartilage penetration and damage. The purpose of this Technical Note is to present a reproducible, full arthroscopic suture fixation technique for patellar osteochondritis dissecans lesions. By using the posterior cruciate tibial drill guide, absorbable sutures are passed through the center and the peripheral borders of the lesion resulting in a "spider-parachute-type" fixation with direct fragment compression.