Management of Osteochondral Lesions of the Tibial Plateau: A Systematic Review of Operative Techniques and Reported Outcomes

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 cm² (range, 0.80-6.00 cm²). 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.