Internal Fixation of Osteochondritis Dissecans in the Knee

Osteochondritis dissecans (OCD) often requires rigid fixation to promote healing. Whether through an arthroscopic or open approach, the basic principles of fixation remain including anatomic reduction, restoration of cartilage congruity, rigid fixation, and enhancement of the blood supply to the lesion. Internal fixation of OCD has evolved through the years with the development of newer methods of fixation. Early fixation was accomplished through the use of wires, which had the potential to bend and break or migrate, often provided little compression, and eventually had to be removed with a second operation. Later AO and cannulated screws provided the advantage of compression and they could be placed antegrade or retrograde but, like wires, eventually had to be removed. Variable-pitch screws have many of the benefits of standard screws, including compression of the lesion and cannulated options. However, they are headless and can be countersunk in the lesion, obviating the need for removal most of the time. Finally, bioabsorbable implants including nails, pins, and variable-pitch screws provide low-profile designs, bioabsorbable properties, compression of the lesion, and decrease in stress shielding of the lesion. An early reported complication of reactive synovitis has been less common with newer polymers and generally resolves with aspiration. This article discusses the options for internal fixation of OCD lesions.