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Review
. 2021 Apr 15;9(4):2325967121997120.
doi: 10.1177/2325967121997120. eCollection 2021 Apr.

Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

Sachin Allahabadi  1 , Sameer Allahabadi  2 , Ruthvik Allala  2 , Kartik Garg  1 , Nirav K Pandya  1 , Brian C Lau  3
Affiliations
Review

Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

Sachin Allahabadi et al. Orthop J Sports Med. .

Abstract

Background: Osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs), but recognition of the condition has increased.

Purpose: To systematically evaluate the literature on lesion locations and treatment outcomes of OLTPs, whether in isolation or in combination with OLTs.

Study design: Systematic review; Level of evidence, 4.

Methods: A search was performed using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. Case reports and reports based on expert opinion were excluded. Lesion locations as well as outcome measure results were aggregated. The Methodological Index for Non-randomized Studies score was used to assess methodological quality when applicable.

Results: Included in this review were 10 articles, all published in 2000 or later. Most studies were evidence level 4, and the mean Methodological Index for Non-randomized Studies score was 8.6 (range, 8-10). Overall, 174 confirmed OLTP cases were identified, and the mean patient age was 38.8 years. Of the 157 lesions with confirmed locations, the most common was central-medial (32/157; 20.4%). Of 6 studies on treatment outcomes, all but 1 evaluated bone marrow stimulation techniques. Microfracture of small lesions (<150 mm2) was the most common treatment utilized. Imaging and functional outcomes appeared favorable after treatment. The data did not support differences in outcomes between isolated OLTPs and OLTPs with coexisting OLTs.

Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or coexisting lesions and isolated lesions; and head-to-head comparison of treatments, such as microfracture, bone marrow-derived cell transplantation, and osteochondral autografts/allografts.

Keywords: ankle; articular cartilage; articular cartilage resurfacing; osteochondral lesion; osteochondritis dissecans; tibial plafond.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: N.K.P. has received consulting fees from OrthoPediatrics and educational support from Evolution Surgical. B.C.L. has received research support from Arthrex and Wright Medical and educational support from Smith & Nephew and SouthTech Orthopedics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for study inclusion. Ten full-text articles were included.
Figure 2.
Figure 2.
Map of aggregated osteochondral lesions of the tibial plafond from the included studies based on the zone description by Elias et al. Data from You et al were excluded from the aggregated numbers in this figure, as there was a lack of consensus between reviewers on the number of lesions and lesion locations on magnetic resonance imaging evaluation without arthroscopic confirmation.
See this image and copyright information in PMC

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