ANTEGRADE DRILLING FOR OSTEOCHONDRITIS-DISSECANS OF THE KNEE

Twenty-four knees with osteochondritis dissecans of the femoral condyl es failed a conservative program and were treated with antegrade drill ing. To our knowledge, this represents the largest reported series usi ng this technique. The average age at the time of surgery was 13 years 6 months. Seventeen patients had open physes, and four were skeletall y mature. Nineteen lesions involved the medial femoral condyle, and fi ve involved the lateral femoral condyle. The average follow-up was 5 y ears. Postoperative evaluation included rating by the International Kn ee Documentation Committee (IKDC) form and the Hughston Rating Scale f or osteochondritis dissecans. Twenty of the 24 lesions healed after an tegrade drilling, and the average time of healing was 4 months. Accord ing to the criteria of the IKDC grading form, 14 were normal, six near ly normal, three abnormal, and one severely abnormal. The results of t he Hughston Rating Scale were similar: 15 were excellent, seven good, one fair, and one poor. Only two of the four skeletally mature patient s healed after antegrade drilling. Antegrade drilling is an effective method of treatment for osteochondritis dissecans of the knee that occ urs in adolescents with open physes. This operation is not as likely t o result in a successful outcome in patients with closed physes; conse quently, other methods should be considered in skeletally mature patie nts.