Non-Operative Management for Osteochondral Lesions of the Tibial Plafond Results in Minor Improvements of Patient-Reported Outcomes: A 2-Year Prospective Follow-Up Study

ObjectiveOsteochondral lesions of the tibial plafond (OLTP) are considered rare, and to date the treatment for these lesions has solely focused on operative management. The aim of this study was to prospectively assess the 2-year patient-reported outcomes, radiological outcomes, and adverse outcomes for the non-operative treatment of patients with a symptomatic OLTP.DesignEighteen patients with a symptomatic OLTP who underwent non-operative treatment were prospectively assessed. The primary outcome concerned the numeric rating scale (NRS) for pain during weightbearing from baseline to 2-year follow-up. Secondarily, the patient-reported outcomes (PROMs) NRS during rest, running, and stairclimbing, as well as the Foot and Ankle 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.ResultsThe 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-year follow-up, <i>P</i> = 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), <i>P</i> = 0.2. In 10 (77%) out of 13 cases, signs of lesion filling or no change was observed. 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.ConclusionsNon-operative management for OLTP resulted in minor improvements of patient-reported pain and functional outcomes up to 2-year follow-up. The conversion to surgery rate was 6%. Radiologically, lesion size and filling were found to remain stable at CT follow-up. Moreover, on average 9 out of 10 patients were able to participate in sport and could return to, or remain at, their preinjury work activities.