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Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?

  • Symposium: Osteochondritis Dissecans
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Early diagnosis and successful treatment of juvenile osteochondritis dissecans (JOCD) is essential in preventing articular degeneration at a young age. Surgical treatment of stable JOCD lesions failing nonoperative treatment involves retroarticular or transarticular drilling to induce revascularization and healing. Multiple case series report high healing rates and infrequent complications for both retroarticular and transarticular drilling modalities; however, it is unclear from these individual reports whether one mode of drilling provides higher healing rates.

Questions/purposes

We asked whether transarticular or retroarticular drilling of stable JOCD lesions results in differing patient-oriented outcomes, rates of radiographic healing, time to radiographic healing, and complication rates.

Methods

We systematically reviewed the short-term clinical outcomes of retroarticular and transarticular drilling of stable OCD lesions. PubMed and additional sources identified 65 studies; 12 studies met inclusion criteria.

Results

Heterogeneity and quality of studies limited review to qualitative analysis. No clear differences were seen in patient-oriented outcomes after treatment with either drilling modality. Radiographic healing for JOCD lesions drilled retroarticularly occurred in 96 of 111 (86%) lesions in an average of 5.6 months. Transarticular drilling of JOCD lesions resulted in 86 of 94 (91%) lesions healing by radiography in an average of 4.5 months. No complications were reported for either drilling modality.

Conclusions

Retroarticular and transarticular drilling of stable lesions results in comparable short-term patient-oriented outcomes and radiographic healing. Further high-quality comparative studies are required to adequately compare drilling modalities, clearly define radiographic healing, and patient-oriented outcomes after nonoperative treatment.

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Author information

Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Matthew J. Gunton MD, Colin R. Shaw BSc (Hons), MSc & M. Lucas Murnaghan MD, MEd, FRCSC

  2. The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Matthew J. Gunton MD, Colin R. Shaw BSc (Hons), MSc & M. Lucas Murnaghan MD, MEd, FRCSC

  3. Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    James L. Carey MD, MPH

Authors
  1. Matthew J. Gunton MD
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  2. James L. Carey MD, MPH
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  3. Colin R. Shaw BSc (Hons), MSc
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  4. M. Lucas Murnaghan MD, MEd, FRCSC
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Correspondence to M. Lucas Murnaghan MD, MEd, FRCSC.

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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at the University of Toronto, Toronto, Ontario, Canada; and the University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

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Gunton, M.J., Carey, J.L., Shaw, C.R. et al. Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?. Clin Orthop Relat Res 471, 1144–1151 (2013). https://doi.org/10.1007/s11999-011-2237-8

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  • DOI: https://doi.org/10.1007/s11999-011-2237-8

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