Arthroscopic Fixation of Unstable Adolescent Knee Osteochondritis Dissecans With Structural Tibial Cancellous Bone Autograft

The treatment of knee osteochondritis dissecans in young patients remains challenging. Unstable or displaced lesions and those unresponsive to conservative management require surgical treatment. Because the articular surface morphology is complex and patient-specific, preservation and fixation of the native osteochondritis dissecans fragment are ideal for maintaining anatomic congruity. Structural bone grafting is desirable in cases of unstable lesions with substantial subchondral bone loss because it provides effective defect filling, greater mechanical support for large defects, and resistance to postoperative lesion collapse. Arthroscopy offers several advantages over traditional open approaches through an arthrotomy, including reduced surgical invasiveness, improved visualization of intra-articular pathology, and accelerated postoperative recovery. However, studies describing the optimal arthroscopic techniques are limited. Therefore, this article aims to describe a step-by-step arthroscopic technique of structural strip-shaped tibial cancellous bone grafting for unstable adolescent knee osteochondritis dissecans lesions.