Extra-articular, Intraepiphyseal Drilling for Osteochondritis Dissecans of the Knee  Andrew T. Pennock, M.D., James D. Bomar, M.P.H., Henry G. Chambers, M.D.  Arthroscopy Techniques  Volume 2, Issue 3, Pages e231-e235 (August 2013) DOI: 10.1016/j.eats.2013.02.012 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 The equipment shown is typically readily available in the operating room. The second item from the right is the offset wire guide and is optional. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Anteroposterior view of right knee showing OCD on medial femoral condyle. (B) Lateral view of same knee showing depth and length of lesion. (C) The merchant view in this case is unremarkable. (D) The development of the sclerotic rim is often best appreciated on the Rosenberg view. The arrows indicate the border of the OCD. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 The coronal magnetic resonance image confirms the presence of the OCD lesion and the sclerotic rim but shows no obvious breach of the overlying articular cartilage. The arrows indicate the border of the OCD. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 4 The knee is flexed approximately 45° to re-create the Rosenberg view and to facilitate passage of the fluoroscopy machine under the operating room table to easily go back and forth between the lateral and Rosenberg views. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) As shown in a right knee (the left side of the image is proximal and the right side is distal), by use of the wire guide, the first K-wire is advanced to the lateral cortex of the femur just below the level of the physis. (B) Once the appropriate trajectory is confirmed, the K-wire is driven antegrade toward the center of the lesion. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 6 (A) As shown in a right knee (the left side of the image is proximal and the right side is distal), the initial K-wire is left in place and used with the guide to make the subsequent perforations into the subchondral bone. (B) Rosenberg and (C) lateral views are taken to confirm appropriate placement of the perforations. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 7 (A) Anteroposterior, (B) lateral, and (C) Rosenberg views taken 6 weeks postoperatively show radiographic evidence of OCD healing. Arthroscopy Techniques 2013 2, e231-e235DOI: (10.1016/j.eats.2013.02.012) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions