Osteochondritis Dissecans (OCD) is a condition identified by injury to the subchondral bone of a joint; and is increasing prevalent among our active young population. Lesions are most commonly located in the posterior lateral aspect of the medial femoral condyle. When surgical intervention is indicated for OCD lesions with intact overlying articular cartilage, a retrograde approach, although more technically challenging, drills the subchondral bone from behind without damaging the articular cartilage and decreases the risk for degeneration and osteoarthritis. The purpose of this study is to determine a safe and reproducible bony entry point as defined by consistent anatomic landmarks, tunnel trajectory as defined by an angle referenced to the longitudinal axis of the femur, and safe distance and/or tunnel diameter able to course the medial femoral condyle and reach the OCD target without damaging the articular and physeal cartilage.
This anatomic study supports that drilling OCD lesions of the medial femoral condyle in an all extra-physeal all extra articular fashion can be safe and reproducible when using referenced angles and consistent external landmarks. It should be noted that all images and corresponding 3D models are of the knee in full extension. Clinically, this surgery is performed with the knee in flexion, which would narrow the posterior window and potentially make an anterior portal more favorable.
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