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Lee et al
observed that the sports subscale of the FAAM score was
significantly improved, their postoperative level of sports
activity was significantly lower than their previous level
before the surgery. Among the 8 questions in the sports subscale of the FAAM score (online Appendix A), we think that
the question of "Ability to participate in your desired sport
as long as you like" is most consistent with the level of
sports activity. At the final follow-up, 10 of 16 patients continued to report "extreme difficulty" or "Unable to do" as
the answer for this question. Based on this result, the phenomenon of the decline in the level of sports activity despite
the improvement in the sports subscale of the FAAM score
can be explained.
Although there have been scant data regarding osteochondral lesion of the tibial plafond because of its rarity,
Elias et al10,11 investigated the frequency of osteochondral
lesions of the tibial plafond by location. They included a
total of 38 patients in the study and it was the largest report
of osteochondral lesions of the tibial plafond. In their study,
the most common location of osteochondral lesions of the
tibial plafond was the centromedial zone. Ross et al28 also
reported the centromedial zone as the most frequent location of the tibial osteochondral lesions. On the other hand,
the most common locations of osteochondral lesions of the
tibial plafond was the anterior zone (zone 1, 2, and 3) in the
present study. Similarly, Cuttica et al8 found that the most
common locations were the anterolateral and anterocentral
zones. The frequency of location of these rare lesions
seems to be variable. Further studies with a large sample
size are necessary to get a better understanding of this rare
lesion.

follow-up period could have prevented us from observing
whether additional complications occurred over time.

Limitation

1. Alexander AH, Lichtman DM. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans).
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2.
Athanasiou KA, Niederauer GG, Schenck RC, Jr.
Biomechanical topography of human ankle cartilage. Ann
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3. Baltzer AW, Arnold JP. Bone-cartilage transplantation
from the ipsilateral knee for chondral lesions of the talus.
Arthroscopy. 2005;21(2):159-166.
4. Bui-Mansfield LT, Kline M, Chew FS, Rogers LF, Lenchik
L. Osteochondritis dissecans of the tibial plafond: imaging
characteristics and a review of the literature. AJR Am J
Roentgenol. 2000;175(5):1305-1308.
5. Chapman CB, Mann JA. Distal tibial osteochondral lesion
treated with osteochondral allografting: a case report. Foot
Ankle Int. 2005;26(11):997-1000.
6. Choi JI, Lee KB. Comparison of clinical outcomes between
arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol
Arthrosc. 2016;24(7):2140-2147.
7. Clement ND, MacDonald D, Simpson AH. The minimal
clinically important difference in the Oxford Knee Score and

Our study has several limitations. First, this was a retrospective study and did not have a control group. Second, the
sample size was small, which may have resulted in a type II
error caused by low statistical power. However, it reflects
the low incidence of this rare lesion. With a larger sample
size, our conclusions might be more convincing. Further
long-term and prospective randomized studies with larger
samples would be helpful to estimate clinical outcomes of
this rare lesion and establish optimal treatment guideline.
Third, there were many concomitant procedures performed
in addition to the arthroscopic microfracture. If we included
only isolated osteochondral lesion of the tibial plafond, the
study would have strengthened our findings. However, as
many patients with an osteochondral lesion have additional
extra-articular pathology, we do not believe that the performance of additional procedures affected the results. Fourth,
we gathered the preoperative clinical scores after the surgery. As the information was based on the patients' memory,
it might cause a recall bias. Lastly, the relatively short

Conclusion
Arthroscopic microfracture provided satisfactory clinical
outcomes for osteochondral lesions of the tibial plafond.
Though all the patients in this study were able to return to
sports activity after the surgery, the postoperative level of
sports activity was significantly lower than their preoperative level.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.

Supplemental Material
Supplementary material is available online with this article.

ORCID iDs
Wonyong Lee, MD,
Sterling Tran, BS,

https://orcid.org/0000-0002-5576-1283
https://orcid.org/0000-0003-2202-8672

References

https://www.orcid.org/0000-0002-5576-1283 https://www.orcid.org/0000-0003-2202-8672

Foot & Ankle International - September 2019

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