Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee.

BACKGROUND: Osteochondritis dissecans of the knee is an increasingly frequent diagnosis in the skeletally immature, in whom it is known as juvenile osteochondritis dissecans (JOCD). Although many stable lesions heal with nonoperative treatment, surgical management may be necessary when this treatment fails. Our objective is to determine if extraarticular drilling is an effective treatment for JOCD.

METHODS: Patients who underwent extraarticular drilling for stable JOCD of the knee at the authors' institution between 1998 and 2006 were identified. Demographic information, the location of the lesion, duration of symptoms before surgery, occurrence of complications, postoperative course, and length of follow-up were documented from each patient's medical record. The outcome measures were normal examination, radiographic evidence of healing, and full return to activity.

RESULTS: Fifteen skeletally immature patients (16 knees) were identified. There were 8 boys and 7 girls, with 8 right and 8 left knees. One girl had bilateral lesions. The lesions were located in the medial femoral condyle in 12 knees and in the lateral femoral condyle in 4 knees. The average duration of symptoms before surgery was 21 months (range, 3 months-9 years). The average age at the time of surgery was 12 years, 4 months (range, 9-15 years). There were no intraoperative or postoperative complications. The average follow-up was 21 months (range, 8-38 months). Three of the 15 patients were lost to follow-up. In the remaining 12 patients, 12 knees had excellent outcomes with full return to activities, normal examinations, and radiographic evidence of healing. One knee had fair results. On average, these criteria were met at 8.5 months after surgery.

CONCLUSIONS: When nonoperative management of stable JOCD fails, arthroscopic extraarticular drilling is an effective treatment to protect the articular surface and promote bone healing.

LEVELS OF EVIDENCE: Level IV case series.