Osteochondral Lesions of the Distal Tibial Plafond: Localization and Morphologic Characteristics with an Anatomical Grid

Abstract

Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. Material and Methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3×3 grid configuration. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, zone 7 was most posterior and medial, and zone 9 was the most posterior and lateral. The grid was designed with all 9 zones being equal in surface area. Two observers reviewed MRI examinations of 38 patients (12 males and 26 females; mean age, 38.7 years; age range, 10 to 68 years) with reported OLTPs. We recorded the frequency of involvement and size of lesion for each zone. A chart review was performed. Results: Of the 38 OLTP found in this study, 14 (37%) of the lesions were on the medial tibial plafond [zones 1, 4 and 7] and 11 (29%) involved the lateral tibial plafond [zones 3, 6 and 9]; 13 lesions (34%) localized to the center third of the plafond [zones 2, 5 and 8]. Nine of the lesions (24%) were on the anterior tibial plafond [zones 1, 2 and 3], 15 lesions (39%) predominately involved the posterior plafond [zones 7, 8 and 9], and 14 lesions (37%) localized to the central third of the plafond [zones 4, 5 and 6]. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). Six of 38 ankles had both a talar osteochondral lesion and an OLTP. Of these, only one was a ‘kissing’ lesion. Chart review revealed that all subjects had ankle pain at time of MRI examination. Conclusion: We conclude that osteochondral lesions of the distal tibial plafond must be considered in the differential diagnosis of patients with symptomatic ankles and that no location had a significantly higher incidence.

Keywords

Osteochondral Lesion OLT Distal tibia Tibial Plafond Osteochondritis

Get full access to this article

View all access options for this article.

References

1. Bauer

Jonnson

Linden

: Osteochondritis dissecans of the ankle. A 20-year follow-up study. J Bone Joint Surg Br. Jan;69(1):93–6, 1987.

2. Berndt

Harty

: Transchondral fractures (Osteochondritis Dissecans) of the talus. J. Bone Joint Surg Am. 41-A:988–1020, 1959.

3. Bui-Mansfield

Kline

Chew

Rogers

Lenchik

: Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature. Am. J Roentgenol. 175(5):1305–8, 2000.

4. Canale

Belding

: Osteochondral lesions of the talus. J Bone Joint Surg Am. 62(1):97–102, 1980 Jan.

5. Canosa

: Mirror image osteochondral defects of the talus and distal tibia. Int Orthop. 18(6):395–6, 1994.

6. Chen

Wertheimer

: Centrally located osteochondral fracture of the talus. J Foot Surg. 31(2):134–140, 1992 Mar-Apr.

7. Crotty

Brogdon

: Posttraumatic osteochondral defect of the distal tibia. Emerg Radiol. (5):438–441, 1998.

8. Elias

Jung

Raikin

: Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems. Foot Ankle Int. Mar;27(3):157–66, 2006.

9. Elias

Zoga

Morrison

: Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int. 2007 Feb; 28(2):154–61.

10.

10. Flick

Gould

: Osteochondritis dissecans of the talus (transchondral fractures of the talus): Review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 5(4):165–185, 1985 Jan-Feb.

11.

11. Hall

: Osteochondritis dissecans of the tibial plafond. Am J Roentgenol. May; 176(5):1328–9, 2001.

12.

12. Mologne

Ferkel

: Arthroscopic treatment of osteochondral lesions of the distal tibia. Foot Ankle Int. Aug; 28(8):865–72, 2007.

13.

13. Parisien

Vangness

: Operative arthroscopy of the ankle. Three years experience. Clin Orthop Relat Res. Oct; (199):46–53,1985.

14.

14. Sijbrandij

Van Gils

Louwerens

De Lange

: Posttraumatic subchondral bone contusions and fractures of the talotibial joint: occurrence of “kissing” lesions. AJR Am J Roentgenol. Dec;175(6):1707–10, 2000.

15.

15. Sopov

Liberson

Groshar

: Bilateral distal tibial osteochondral lesion: a case report. Foot Ankle Int. 22(11):901–4, 2001.

16.

16. Stone

: Osteochondral Lesions of the Talar Dome. J Am Acad Orthop Surg. 4(2):63–73, 1996.