 Osteocondritis disiccans, or OCD, is a joint condition in which a focal area of subchondral bone and cartilage becomes unhealthy and risks separation from the surrounding bone and joint surface. Most often observed in the needs of children and adolescents, this condition can result in knee pain, swelling, and instability that can, in turn, lead to premature osteoarthritis. The more common, early form of the condition is referred to as stable OCD. Nonoperative treatment is the standard of care in patients with stable OCD and open growth plates. It's estimated that up to 43% of these patients will ultimately require surgical intervention. A recent study compared the two drilling techniques typically used to treat stable OCD, transarticular drilling, and retroarticular drilling. The findings reported in the American Journal of Sports Medicine indicate that while outcomes were similar between the two techniques, two years after surgery, transarticular drilling produced more advanced signs of healing in the shorter term and allowed for quicker return to sports for patients. As their names suggest, transarticular and retroarticular drilling differ in how they approach an OCD lesion with respect to the articular cartilage of the knee. The transarticular approach passes through the cartilage to reach the site of the injury. Meanwhile, the retroarticular approach passes through the back side of the bone to avoid damaging the cartilage that overlies an OCD lesion. In a first, researchers compared the drilling techniques through a randomized controlled trial of 91 skeletally immature patients between the ages of 9 and 15. 51 patients who underwent transarticular drilling and 40 who underwent retroarticular drilling were included in the final analysis. In terms of surgical characteristics, performing the transarticular approach proved to be less time consuming. Both tourniquet time and fluoroscopy time were significantly shorter than for the retroarticular approach. With respect to time required to return to sports, transarticular drilling again proved speedier. On average, patients in the transarticular group were cleared to return to sports at 4.1 months, while those in the retroarticular group were cleared at 5.8 months. A similar advantage was observed in healing parameters measured by radiographic imaging. At 6 and 12 months, patients in the transarticular group showed better median ossification and boundary scores than those in the retroarticular group. Interestingly, however, these differences did not persist at the two-year follow-up. In addition, the two groups reported similar scores on four different patient-reported outcome measures at 6, 12, and 24 months, suggesting that both techniques were effective in restoring normal knee function and activity levels. The two-year follow-up period could be interpreted as one limitation of this study, as this did not allow for the assessment of long-term joint health, possible late-stage OCD recurrence, or the eventual onset of degenerative joint disease. But for many young athletes today, the faster short-term healing observed for transarticular drilling could be meaningful. More work is needed to explore the factors that might contribute to this faster healing and determine the best overall approach to treating young patients with OCD.