title: Drilling juvenile osteochondritis dissecans: retro- or transarticular?
abstract: BACKGROUND
  Early diagnosis and successful treatment of juvenile osteochondritis dissecans (JOCD) is essential in preventing articular degeneration at a young age. Surgical treatment of stable JOCD lesions failing nonoperative treatment involves retroarticular or transarticular drilling to induce revascularization and healing. Multiple case series report high healing rates and infrequent complications for both retroarticular and transarticular drilling modalities; however, it is unclear from these individual reports whether one mode of drilling provides higher healing rates.
  
  
  OBJECTIVE
  We asked whether transarticular or retroarticular drilling of stable JOCD lesions results in differing patient-oriented outcomes, rates of radiographic healing, time to radiographic healing, and complication rates.
  
  
  METHODS
  We systematically reviewed the short-term clinical outcomes of retroarticular and transarticular drilling of stable OCD lesions. PubMed and additional sources identified 65 studies; 12 studies met inclusion criteria.
  
  
  RESULTS
  Heterogeneity and quality of studies limited review to qualitative analysis. No clear differences were seen in patient-oriented outcomes after treatment with either drilling modality. Radiographic healing for JOCD lesions drilled retroarticularly occurred in 96 of 111 (86%) lesions in an average of 5.6 months. Transarticular drilling of JOCD lesions resulted in 86 of 94 (91%) lesions healing by radiography in an average of 4.5 months. No complications were reported for either drilling modality.
  
  
  CONCLUSIONS
  Retroarticular and transarticular drilling of stable lesions results in comparable short-term patient-oriented outcomes and radiographic healing. Further high-quality comparative studies are required to adequately compare drilling modalities, clearly define radiographic healing, and patient-oriented outcomes after nonoperative treatment.
authors.affiliation: Division of Orthopaedics, Department of Surgery, University of Toronto, and The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gunton
authors.forename: James L
authors.initials: JL
authors.lastname: Carey
authors.forename: Colin R
authors.initials: CR
authors.lastname: Shaw
authors.forename: M Lucas
authors.initials: ML
authors.lastname: Murnaghan
mesh_terms: D001182:Arthroscopy; D002648:Child; D006801:Humans; D010008:Osteochondritis Dissecans / Q000601:surgery*; D011183:Postoperative Complications; D015641:Radiography, Interventional; D016896:Treatment Outcome; D014945:Wound Healing