AJSM - 2026-07-01 - Journal Article; Systematic Review
Management of Osteochondral Lesions of the Tibial Plateau: A Systematic Review of Operative Techniques and Reported Outcomes.
Goli PS, Touhey DC, Brophy RH, Matava MJ, Smith MV, Knapik DM
Topics
Key Takeaway
OCAT was used in 80% of tibial plateau osteochondral lesion cases but carried a 30.1% failure rate, compared to 6.3% for both microfracture and OAT.
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Summary
This systematic review examined operative indications, techniques, and outcomes for tibial plateau osteochondral lesions across 24 studies and 581 patients (mean age 42.2 years). Traumatic etiology accounted for 82.6% of cases; lateral plateau involvement in 65.8%; weighted mean lesion area 2.29 cm². OCAT dominated treatment (80.2%) but had a 30.1% failure rate, while IKDC improved from 39.5 to 66.2 and Lysholm from 62.1 to 91.7 across the cohort.
Key Limitation
The predominance of OCAT cases (80.2%) and small sample sizes for alternative techniques preclude any valid head-to-head efficacy comparison, meaning the apparent superiority of microfracture and OAT in failure rates is likely confounded by selection bias and lesion size differences.
Original Abstract
BACKGROUND
Management of tibial plateau osteochondral (TP-OC) lesions remains challenging due to limited reported treatment options and outcomes.
PURPOSE
To systematically review the literature to better understand current operative indications, techniques, and outcomes for TP-OC lesions.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Studies reporting on the treatment of TP-OC lesions from inception to August 2025 were identified using the Cochrane Library, EMBASE, and PubMed databases. Inclusion criteria included studies reporting on patients undergoing operative management with injury cause, lesion size and location, reported technique (repair vs restoration), and postoperative outcomes, including complications and patient-reported outcome measures (PROMs).
RESULTS
A total of 24 studies, consisting of 581 patients (mean age, 42.2 years; range, 12-77 years), were identified. Weighted mean follow-up was 106.0 months (range, 3-408 months). Traumatic injury was reported in 82.6% (n = 256/310) of patients. Lesions were most commonly located on the lateral tibial plateau (65.8%; n = 340/517), with a weighted mean lesion area of 2.29 cm 2 (range, 0.80-6.00 cm 2 ). Operative treatments included osteochondral allograft transplant (OCAT) (80.2%; n = 466/581), microfracture (6.7%; n = 39/581), osteochondral autograft transfer (OAT) (6.4%; n = 37/581), autologous chondrocyte implant (4.8%; n = 28/581), and osteochondral scaffold placement (1.9%; n = 11/581). Meniscal allograft transplant (MAT) was the most common concomitant procedure, reported in 54.0% (n = 210/389) of patients. Treatment failure, including graft failure, was the most common postoperative complication, reported in 26.0% (n = 106/408) of patients. Specifically, failure occurred in 30.1% (n = 96/318) of patients undergoing OCAT, 6.3% (n = 1/16) undergoing microfracture, and 6.3% (n = 2/32) undergoing OAT. Improvements in weighted mean PROM scores were reported for International Knee Documentation Committee (from 39.5 to 66.2), Lysholm (from 62.1 to 91.7), and Tegner (from 3.6 to 5.9) scores.
CONCLUSION
Tibial plateau osteochondral lesions most commonly occurred secondary to trauma and frequently involved the lateral compartment. OCAT was the most frequently performed surgical treatment, whereas MAT was the most commonly performed concomitant procedure. Improvements were noted in several PROMs. Graft failure was the most frequently reported complication, reported in 30% of patients after OCAT.