Outcomes of extra-articular,
intra-epiphyseal drilling for OCD
lesions of the knee with intact
articular cartilage
Eric W Edmonds, MD
Jay Albright, MD
Scott J Mubarak, MD
Tracey Bastrom, MA
Henry G Chambers, MD
Introduction
• Juvenile Osteochondritis
dissecans (JOCD)
– Subchondral lesion with
degrees of osseous
resorption, collapse, and
sequestrum formation,
possible delamination of
articular cartilage in the
skeletally immature
Guhl Classification
Management
• Non-operative
management:
– Activity modification, PT,
casting
– 50% heal in 10 to 18
months (Cahill, 1989)
• Operative techniques:
– Intra-articular drilling
– Four outcome studies: 82%
to 95% successful union
Outcomes of Intra-articular
Drilling
• Multiple perforations in the
previously intact cartilage.
Outcomes of Intra-articular
Drilling
• Less perpendicular perforations in
the sclerotic rim of the lesion.
Purpose
• Evaluate:
– Extra-articular, intra-epiphyseal drilling
– Does not damage intact articular cartilage
– Increased fenestration of sclerotic rim
Methods
•
•
•
•
Retrospective review
Years 1997 to 2005
68 children, 75 knees (76 OCD lesions)
Inclusion criteria
– Open growth plates, failed six months
conservative management, arthroscopically
confirmed intact articular cartilage
• Exclusion criteria
– Arthroscopic drilling through cartilage, detached
cartilage, or closed growth plates.
Technique
1. Diagnostic arthroscopy to confirm
Guhl grade
2. A 0.062 inch K-wire, percutaneous,
intra-epiphyseal to center of lesion
Technique
1.This center-center “guide” wire is then
preserved as a guide for further wire
placement.
Technique
• A parallel wire
guide is used to
direct a subsequent
“drilling” K-wire
• 15 to 20 holes are
drilled through the
sclerotic rim
Outcome Determination
• Radiographic
outcomes
– Success: complete
resolution of OCD
lesion
• Clincial outcomes
– Failure: further
intervention
Results
• 59 lesions with complete data
–17 lateral condyles and 42 medial
condyles
• Mean age 13.4 years (8 to 18.6)
• 15 girls and 36 boys
Results
• 52 lesions with
successful healing
(87%)
• 7 lesions requiring
further intervention
(13%)
Pre-drilling
Post-drilling
Results
• Mean duration to healing:
– 11.8 months (1.3 to 47.3)
• Mean follow-up:
– 23.7 months (1.3 to 72)
Duration to Complete Healing
Time
(months)
12
6
3
Each Lesion in Study
Failures
• 2nd operation, mean 18 months
after index operation:
–4 required repeat drillings
–2 required repeat drilling with
bone graft
–1 required trans-articular drilling
with osteochondral tack
Failures
• 3rd operation: requiring
matchstick bone graft and
chondroplasty
– 39 months after the index
procedure (15 months after
the second procedure of
repeat drilling)
Complications
• No other complications
resulted from this procedure
Comparing Our Results
• Our rate of 87% complete radiographic
healing represents comparable
outcomes to previous intra-articular
drilling reports of 82% to 95%
successful union
Discussion
• Extra-articular, intra-epiphyseal drilling of
OCD lesions
– Similar rate of healing compared to intraarticular drilling
– Improved fenestration of subchondral rim
– Nullifies damage to the overlying articular
cartilage
Conclusion
• Less iatrogenic
damage
• A safe and
effective technique
Thank You