Background: Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.
Patients And Methods: A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).
Results: Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.
Discussion: Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.
Level Of Evidence: IV.
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Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review.
Orthop Traumatol Surg Res
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Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; CHU Sainte-Justine, 3175, chemin de la Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic surgery, 5400, boulevard Gouin Ouest, Montreal, QC H4J 1C5, Canada. Electronic address:
Background: Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage.
View Article and Find Full Text PDFTransarticular Versus Retroarticular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Multicenter Randomized Controlled Trial by the ROCK Group.
Am J Sports Med
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Stanford University Hospital, Palo Alto, California, USA.
Background: When stable osteochondritis dissecans (OCD) lesions of the femoral condyle in a skeletally immature patient fail to heal with nonoperative methods, the standard of care treatment is condylar OCD drilling. Two primary OCD drilling techniques have been described, but no prospective studies have compared their relative effectiveness.
Purpose/hypothesis: The purpose of this study was to compare the healing and function after transarticular drilling (TAD) with that after retroarticular drilling (RAD).
Outcome of retroarticular drilling for osteochondritis dissecans of the talus in a pediatric population.
Foot Ankle Surg
July 2022
University of Montreal, 2900 boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada; CHU Ste-Justine, 7905-3175 Côte Ste-Catherine, Montréal, QC, H3T 1C5, Canada; Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin O, Montreal, QC, H4J 1C5, Canada. Electronic address:
Background: Outcomes of bone marrow stimulation for osteochondritis dissecans (OCD) of the talus in pediatric patients is not optimal. The objective was to evaluate the retroarticular drilling technique for talar OCD.
Methods: A retrospective case-series study of pediatric cases treated for talar OCD with retroarticular drilling was done.
Retroarticular Core Decompression with Biologic Augmentation for Juvenile Osteochondritis Dissecans of the Knee.
Arthrosc Tech
July 2020
Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.
Juvenile osteochondritis dissecans (OCD) of the knee is a rare condition of subchondral bone that has secondary effects on articular cartilage as the condition advances. Traditional treatment for early-stage OCD involves different types of drilling procedures that work to stimulate healthy bone formation via creeping substitution. This article describes a technique that involves a complete removal, or decompression of an early-stage OCD, while preserving the overlying articular cartilage that is augmented with bone grafting and bone marrow aspirate concentrate.
View Article and Find Full Text PDFThe Surgical Management of Osteochondritis Dissecans of the Knee in the Skeletally Immature: A Survey of the Pediatric Orthopaedic Society of North America (POSNA) Membership.
J Pediatr Orthop
January 2018
*Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia †Perelman School of Medicine at the University of Pennsylvania §Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA ‡Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD ∥Department of Orthopedics, St Luke's Clinics, Boise, ID.
Background: While the characteristics of osteochondritis dissecans (OCD) of the knee that require surgery to heal have been described, several surgical techniques/procedures exist with no consensus established regarding timing of treatment and specific surgical intervention. In this study, we aim to determine current trends in surgical treatment for OCD lesions in the skeletally immature who have failed 6 months of nonoperative management by surveying a large cohort of orthopaedic surgeons.
Methods: An electronic survey designed using REDCap to capture surgeon treatment preferences for OCD lesions was distributed to members of the Pediatric Orthopaedic Society of North America (POSNA).
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