Arthroscopic Treatment of Osteochondritis Dissecans (OCD) of the Knee includes a novel retrograde drilling and bone grafting technique developed by Dr. Chudik that addresses OCD lesions from behind the cartilage rather than through it. The technique allows the unstable bone bed to be treated and stabilized without disrupting the overlying cartilage surface. Dr. Chudik also uses specialized instruments of his own design for the broader range of OCD treatments, from drilling through fixation to grafting.
What Is Arthroscopic Knee OCD Treatment?
Osteochondritis dissecans (OCD) is a localized injury or condition affecting the bone just below the cartilage surface of a joint. OCD is often associated with repetitive trauma and sports. In OCD, the bone just below the joint surface fails and fractures from repetitive stress or from interruption of its local blood supply. The overlying cartilage, no longer properly supported, can separate, and an OCD fragment of bone and cartilage can break loose.
In the knee, OCD most commonly affects the medial femoral condyle, followed by the lateral femoral condyle, the patella, and the trochlea. If neglected, an OCD fragment can come loose, catch in the joint (causing pain, locking, clicking), and leave a hole in the joint surface that accelerates wear and arthritis.
Dr. Chudik treats knee OCD across the spectrum of presentations and developed novel techniques specifically for stable lesions where the cartilage is intact but the underlying bone has lost its support. The retrograde drilling and bone grafting technique addresses these lesions from behind the cartilage rather than through it, preserving the native cartilage surface.
Development Rationale
Stable OCD lesions with intact overlying cartilage present a treatment dilemma. The bone bed needs to be stimulated to heal or grafted to restore stability, but the overlying cartilage is intact and worth preserving. Conventional approaches drill through the cartilage to access the bone, which damages the very cartilage the treatment is trying to preserve.
Dr. Chudik developed a retrograde technique that:
- Approaches the OCD lesion from behind (through the bone) rather than through the cartilage
- Uses fluoroscopic X-ray guidance to drill a tunnel that reaches the lesion without breaching the joint surface
- Fills the tunnel with bone grafting material to create a stable joint surface
- Preserves the native cartilage entirely
The technique is appropriate for stable OCD lesions where preserving the cartilage is the priority. For unstable, partially separated, or displaced lesions, other techniques (fixation, grafting through the cartilage, or fragment removal with cartilage restoration) are used.
Dr. Chudik also designs specialized instruments for the full range of OCD treatments, supporting precise small-incision approaches to a condition where joint preservation matters.
Who Is a Candidate?
Candidates for the retrograde drilling technique typically have:
- A stable OCD lesion with intact overlying cartilage on MRI
- Mechanical or pain symptoms suggesting the bone bed is contributing to instability
- Failure of non-surgical treatment in skeletally immature patients
- Adequate access to the lesion location for retrograde drilling
For unstable or displaced lesions, candidates are evaluated for:
- Fixation of in-situ unstable fragments with bioabsorbable implants
- Osteochondral autograft transfer for displaced lesions with small to medium defects
- Osteochondral allograft transplantation for larger defects in older patients
- Removal of loose bodies when the fragment is not salvageable
Contraindications include knee infection, inability to complete the postoperative program of activity limitation and rehabilitation.
How the Procedure Is Performed
The procedure is performed as outpatient surgery under general anesthesia with local anesthetic at the surgical site.
For the retrograde drilling technique, Dr. Chudik uses arthroscopic visualization combined with intraoperative X-ray guidance to drill a tunnel from outside the cartilage surface to the bone immediately under the OCD lesion. The tunnel approaches the lesion from behind the cartilage, never breaching the joint surface. The tunnel is then filled with bone grafting material that supports the bone bed and creates a stable joint surface. The cartilage above the lesion is left undisturbed.
For unstable, partially separated, or displaced lesions, Dr. Chudik selects from:
- Drilling through the cartilage when retrograde access is not feasible, with the specialized instruments he designed
- Fixation of unstable fragments with bioabsorbable pins, screws, or compression devices
- Osteochondral autograft transfer (OATS) using cylindrical plugs from a non-weight-bearing area
- Osteochondral allograft transplantation using donor cartilage with underlying bone
- Removal of loose bodies that cannot be reattached, followed by debridement of the bone bed
Dr. Chudik discusses options with each patient and helps determine the best treatment for the specific lesion.
Recovery and Rehabilitation
Recovery follows a protected protocol:
- Crutches and non-weight bearing for six weeks, OR hinged knee brace locked in extension for six weeks, depending on the size and location of the lesion
- Wound care: clean and dry for the first 10 to 14 days; light showering after two weeks; no submersion under water for three weeks
- Return to school or sedentary work in less than one week as long as the leg can be elevated
- Physical therapy to restore motion, strength, and proprioception for up to four to six months
After full rehabilitation, Dr. Chudik’s Knee Functional Capacity Evaluation confirms rehabilitation is complete and identifies any errors in movement patterns that put patients at risk for re-injury. Movement patterns are corrected before return to sport.
Return to gentle daily activities is typical at six to eight weeks after surgery. Return to sport is typically six to 12 months after surgery, depending on the severity of the OCD lesion, the procedure performed, and the demands of the sport and position.
Risks and Outcomes
Specific surgical risks include:
- Wound infection
- Bleeding or injury to blood vessels
- Injury to nerves (numbness, weakness)
- Non-union or non-healing of the OCD fragment in repair situations
- Knee stiffness
- Arthritis
The retrograde drilling technique preserves native cartilage, which is the primary advantage over conventional through-the-cartilage drilling for stable lesions. Outcomes for stable lesions treated early are good, with high healing potential in skeletally immature patients. Adult OCD and chronic displaced lesions have less predictable outcomes.
Why Dr. Chudik for Arthroscopic Knee OCD Treatment
Dr. Chudik developed the retrograde drilling and bone grafting technique for stable OCD lesions where preserving the overlying cartilage is the priority. He also uses specialized instruments of his own design across the broader range of OCD treatments. Patient selection, technique selection, and rehabilitation are informed by his experience with the full spectrum of OCD presentations from skeletally immature throwers to older recreational athletes.