Failed nonoperative treatment (3–6 months)

 Unstable lesion by radiographs or magnetic resonance imaging (MRI)

 Adequate anteroposterior (AP) (Fig. 1A) and lateral (Fig. 1B) radiographs are needed to establish the ability to see stable lesions intraoperatively.

 MRI imaging (Fig. 2) is essential for evaluation of stability and cartilage integrity.

 The saphenous nerve and/or its infrapatellar branches are at risk for medial femoral condylar lesions.

 The growth plate is also at risk for damage, particularly without radiographic control during drilling.

 Supine positioning with a leg holder and 90° flexion off the end of the bed and a well-leg holder is adequate (Fig. 3).

 Alternatively, supine positioning with a lateral post and a radiolucent table is also reasonable.

 Standard padding of all extremities is used.

 The fluoroscope should enter from the nonoperative side at an angle perpendicular to the operative knee.

 The arthroscopy equipment should be sufficiently positioned out of the way of the fluoroscope.

 Standard arthroscopy portals are utilized.