When a child or teen has osteochondritis dissecans (OCD) of the knee that does not heal with rest, doctors often turn to a surgery called drilling. The goal is to create small channels in the bone so it can heal. There are two main drilling techniques:
- Transarticular drilling (TAD): goes through the cartilage into the lesion.
- Retroarticular drilling (RAD): comes in from the side of the bone to avoid piercing the cartilage.
This large study included 91 young patients from 14 centers and directly compared the two methods.
Key findings:
- Both techniques worked well: Most patients healed and returned to sports with excellent knee function after two years.
- TAD was faster: Surgery and X-ray time were shorter.
- Healing was quicker with TAD: Patients showed better healing at 6 and 12 months and returned to sports about 2 months earlier (4.1 vs 5.8 months).
- RAD caused more cartilage injuries during surgery (22 percent of cases), though these did not cause problems later.
- By 24 months, outcomes were similar between the two groups.
Takeaway: Both drilling methods are safe and effective, but transarticular drilling may lead to faster healing and earlier return to sports, which can be very important for young athletes.
