Retroarticular drilling and bone grafting of juvenile osteochondritis dissecans of the knee.

We present an effective technique for retroarticular drilling and bone grafting of juvenile osteochondritis dissecans (OCD). A radiolucent bolster is used to flex the knee at 45 degrees, allowing adequate C-arm visualization. A 2-cm incision is made over the iliac spine, and soft tissue is dissected with the use of electrocautery. A 3.5-mm Steinmann pin is driven approximately 5 cm into the iliac crest. With a mallet, the 3.5-mm-long drill sleeve from the Synthes External Fixator Set (Part #395.913; Synthes, Paoli, PA) is tamped over and 1 cm past the guide pin, while cores of autograft cancellous bone are harvested. The same Steinmann pin is inserted over the corresponding aspect of the knee. The Steinmann pin is advanced to approximately 1 cm above the lesion, and the drill guide is once again tapped over the pin. With use of the C-arm, the pin is removed, and a 3.5-mm bit is used to drill the remaining distance into the lesion. The graft is tamped through the drill guide and into position with the reverse end of the bit. This technique may be repeated according to the size of the lesion. Major advantages of this technique include the ease of harvest/transfer of autograft, readily available instrumentation to perform the procedure, and the ability to avoid violation of stable articular cartilage.