Summary

Osteochondral lesions of the tibial plafond (OLTP) are considered rare and their treatment challaging: : Non-operative management for OLTP appears safe and patients did not worsen in patient-reported pain and functional outcomes up-to 2-years follow-up. The conversion to surgery rate was 6%. Radiologically, lesion size and filling were found to remain stable at CT follow-up. Moreover, 9 out of 10

Abstract

Purpose

to prospectively assess the 2-year patient-reported outcomes, radiological outcomes, and adverse outcomes for the non-operative treatment of patients with a symptomatic osteochondral lesion of the tibial plafond (OLTP).

Methods

Eighteen patients with a symptomatic OLTP that underwent non-operative treatment were prospectively assessed. The primary outcome concerned the numeric rating scale (NRS) for pain during weightbearing from pre- to 2-years postoperatively. Secondarily, the patient-reported outcomes (PROMs) NRS during rest, running, and stairclimbing, as well as the foot and outcome score (FAOS) and short-form-36 (SF-36) questionnaires were assessed. CT-scans at median 2 years (IQR: 1.5 – 2) follow-up were reviewed for changes in lesion volume or signs of lesion healing. Return to sports and work rates were evaluated. The conversion to surgery rate and any complications were assessed.

Results

The NRS during weightbearing improved (non- significantly) from a median of 5 (IQR: 3 – 7) out of 10 at baseline to 2 (IQR: 1 – 6) out of 10 at 2-years follow-up, P=0.06. The other NRS subscales, FAOS subscales, and SF-36 did not significantly improve at final follow-up. The follow-up CT-evaluation showed that lesion volume did not change (219 (IQR: 79 – 890) mm3) compared to baseline (226 (IQR: 79 – 890) mm3), P= 0.2. In 10 (77%) cases signs of lesion filling or no change was found. At final follow-up, 93% (13/14) of patients returned to any level of sports, 54% (7/13) of patients returned to preinjury level of sports, and 94% (15/16) of patients returned to work. No adverse events were observed, and 1 (6%) case converted to surgery.

Conclusion

Non-operative management for OLTP appears safe and patients did not worsen in patient-reported pain and functional outcomes up-to 2-years follow-up. The conversion to surgery rate was 6%. Radiologically, lesion size and filling were found to remain stable at CT follow-up. Moreover, 9 out of 10 patients were able to participate in sport and could return to, or remain at, their preinjury work activities.