Osteochondral Lesions of the Tibia (Tibial Plafond)

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Osteochondral Lesions of the Tibia (Tibial Plafond)

A comprehensive patient guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK. This guide explains what an osteochondral lesion of the ankle joint (tibial side) is, why it happens — often after sports injuries and ankle trauma — and the full range of non-surgical and surgical treatments available.

At a Glance: Osteochondral Lesions of the Tibia
ConditionDamage to the cartilage and underlying bone on the ankle (tibial) side of the joint — the “roof” of the ankle, known as the tibial plafond.
How CommonUncommon — roughly 1 tibial-side lesion for every 14 to 20 lesions on the talus (the more usual site).
Most Common CausePrevious ankle injury — fractures, severe or repeated sprains, and sporting trauma.
DiagnosisWeight-bearing X-ray, CT / weight-bearing CT (WBCT) and MRI.
Non-Surgical CareChanging activities, taking weight off the ankle, bracing, custom insoles, physiotherapy, anti-inflammatory medicines and selected injections.
Surgical OptionsKeyhole bone marrow stimulation (microfracture), osteochondral graft transplantation, corrective osteotomy, and salvage fusion or total ankle replacement.
OutlookSurgery reliably improves pain and daily function; return to high-impact sport is less predictable, particularly for larger lesions.
SpecialistMr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

01

What Are Osteochondral Lesions of the Tibia?

An osteochondral lesion is an area of damage to the smooth, slippery cartilage that lines a joint and to the thin layer of bone just underneath it. In the ankle, these injuries most often occur on the talus — the top bone of the foot. Less commonly, they occur on the opposite surface: the lower end of the shin bone (tibia) that forms the “roof” of the ankle joint, called the tibial plafond. Specialists refer to this as an osteochondral lesion of the tibial plafond, or OLTP.

The tibial surface is slightly dish-shaped and covered by firmer cartilage than the rounded talus beneath it, which is one reason damage here is less common. Because the damage sits deep within a joint that carries your full body weight with every step, it can cause persistent deep ankle pain that does not settle on its own. Specialist assessment by a Consultant Foot & Ankle Surgeon in London gives you the widest range of treatment options and the most accurate diagnosis.

02

How Common Are They?

Osteochondral lesions of the tibia are uncommon. For every lesion found on the tibial side of the ankle, there are roughly 14 to 20 on the talus. They are most often identified after an ankle injury, and frequently sit opposite a matching lesion on the talus (known as a “kissing” lesion, because the two damaged areas sit face to face).

Because they are relatively rare and cause the same symptoms as far more common ankle problems — sprains, pinching at the front or back of the joint, and early arthritis — they can be overlooked without dedicated imaging and specialist review. This is one reason a period of ongoing ankle pain after a sports injury deserves proper assessment rather than simply being left to settle.

03

What Causes Them?

  • Post-traumatic (most common): previous ankle fractures, severe or recurrent sprains, and sporting trauma that damage the joint surface.
  • Coexisting talar lesions: tibial lesions often occur together with a matching lesion on the talus, and the two are treated together.
  • Alignment problems and uneven loading: flat feet, high-arched feet, or a fracture that healed slightly out of line can concentrate force onto one part of the joint.
  • Reduced blood supply: a small area of bone under the cartilage does not get enough blood, which weakens it.

There is a strong sports and trauma thread running through these injuries. The same twisting, loading and impact forces that produce ankle sprains, fractures and Achilles tendon ruptures can also injure the cartilage surface of the ankle. Athletes and active patients who sustain a significant ankle injury — including an Achilles tear alongside a twisting injury — are among those who can develop a lesion of this kind.

04

What Are the Symptoms?

  • Deep ankle pain — felt inside the joint, typically worse with activity and weight-bearing.
  • Swelling around the ankle, particularly after exercise.
  • Catching, clicking or locking as the joint moves over the damaged area.
  • Stiffness and a reduced sense of a smooth, gliding ankle.
  • Symptoms that persist after an ankle sprain or fracture has otherwise healed — a common reason patients are eventually referred for specialist imaging.

If your ankle still hurts months after a sprain or a sports injury that “should” have recovered, an osteochondral lesion is one of the causes a specialist will look for.

05

What Investigations Might You Need?

  • Weight-bearing X-rays (taken standing) — usually the first test, showing how the bones line up and any wear that has already developed.
  • CT / Weight-bearing CT (WBCT) — a detailed 3D scan that maps the size and depth of the lesion, and shows any fluid-filled pockets (cysts) in the bone. WBCT is a particular area of Mr Welck’s practice and research.
  • MRI scan — to look at the cartilage, show any swelling inside the bone, and pick up damage to nearby ligaments, tendons or the talus.

These lesions can be subtle and are easily missed on a plain X-ray alone, so specialist imaging and interpretation are important. Mapping the size, depth, any cystic change, kissing lesions and overall alignment is what guides the choice of treatment.

06

Non-Surgical Treatment Options

Non-surgical care suits lesions that cause few or no symptoms, and lesions where the damaged bone and cartilage are still in place and non-surgical treatment has not yet been tried. Many patients begin here:

  • Changing your activities, and a period of putting less weight through the ankle — sometimes using crutches or a boot
  • Supportive footwear and custom insoles to spread pressure away from the damaged area
  • Ankle bracing to settle an irritable joint
  • Physiotherapy to maintain strength, balance and movement
  • Anti-inflammatory medication (oral or topical)
  • Ultrasound-guided injections in selected cases

A structured non-operative programme is often the right first step, and some lesions settle without an operation. Where symptoms persist or the lesion is progressing, surgery is considered.

07

Surgical Options

Surgery is considered if the lesion stays painful or is getting worse. The right operation depends on the size and depth of the lesion, whether there are cysts in the bone, the condition of the facing surface of the talus, and the overall alignment of the ankle and hindfoot. Treatment is highly individualised.

Bone Marrow Stimulation (Microfracture) — Keyhole Surgery

For small, non-cystic lesions (broadly under about 10 mm across and 3 mm deep), tiny channels are made in the exposed bone through keyhole surgery, using a small camera and fine instruments. This draws the body’s own repair cells to the area, where they form a tough scar-cartilage “patch.” It reliably improves pain and everyday function; results for high-impact sport are more variable, and larger lesions tend to leave more lasting ache.

Osteochondral Graft Transplantation

For larger or cystic lesions, the damaged area can be replaced with a plug of healthy cartilage and bone — taken either from the patient (autograft) or from a donor (allograft). Because the tibial roof is awkward to reach, the surgeon may reach it from behind or below, or make a small, carefully planned cut in the bone (an osteotomy) and use a keyhole camera to see the area clearly.

Corrective Osteotomy (Realignment)

If the shin or heel is out of line, cutting and repositioning the bone can shift weight away from the damaged part of the joint, protecting the repair and relieving pain. Correcting alignment is often the difference between a durable result and an early recurrence.

Treating “Kissing” Lesions

Where a matching lesion is present on the talus, both surfaces are treated at the same operation, using the same principles applied to an isolated lesion.

Salvage: Ankle Fusion or Total Ankle Replacement

For very large or deep lesions, or where the joint has already developed significant arthritis or deformity, salvage surgery may be the most reliable option. This includes ankle fusion — joining the bones together so the joint no longer moves — or total ankle replacement. Total ankle replacement preserves movement and gives a more natural walking pattern, and is an area of particular expertise in Mr Welck’s practice.

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading specialist orthopaedic hospitals — and Honorary Associate Clinical Professor at UCL.

His practice is dedicated exclusively to disorders of the foot and ankle, with specialist interest in complex ankle reconstruction, total ankle replacement, cartilage and joint-preserving surgery, and sports injuries of the foot and ankle. He has written over 50 published research papers, has completed two specialist fellowships including training abroad, and carries out research into weight-bearing CT scanning and 3D-printed surgical guides made for each individual patient.

Patients are seen across North and Central London with rapid access to MRI, weight-bearing CT and multidisciplinary care. Every option is discussed openly, and you and Mr Welck agree a plan together that fits your goals. Visit matthewwelck.com to learn more.

09

Frequently Asked Questions

What is an osteochondral lesion of the tibia?

It is an area of damaged cartilage and underlying bone on the tibial (shin-bone) side of the ankle joint — the “roof” of the ankle, or tibial plafond. It usually follows an ankle injury and causes deep, activity-related ankle pain.

How is it different from a lesion on the talus?

The talus (the top bone of the foot) is the far more common site. Lesions on the tibial side are much rarer, can be harder to reach surgically, and the two often occur together as “kissing” lesions that are treated at the same time.

Do I always need surgery?

No. Lesions causing few symptoms, and lesions where the damaged piece has not moved and non-surgical treatment has not yet been tried, are often managed by taking weight off the ankle, bracing, physiotherapy and time. Surgery is reserved for lesions that stay painful or are getting worse.

What is microfracture or bone marrow stimulation?

A keyhole procedure for small lesions where fine channels are made in the bone to encourage the body to grow its own repair tissue. It works well for daily activities; results for high-impact sport are less predictable.

Will I be able to return to sport?

Many patients return to activity, but expectations should be realistic. Lesions on the tibial side alone can make recovery and return to sport slightly less predictable than lesions on the talus, especially if the damaged area is large. Your plan will be tailored to your goals.

Could this lead to ankle arthritis or a replacement?

Untreated or extensive lesions can contribute to joint wear over time. Where significant arthritis or deformity is already present, salvage options such as ankle fusion or total ankle replacement may be discussed.

My ankle still hurts months after a sprain — could this be why?

Possibly. Persistent deep pain, swelling or catching after an ankle sprain, fracture or Achilles injury that “should” have healed is a common reason to look for an osteochondral lesion with specialist imaging.

Where can I see Mr Welck in London?

Mr Welck consults across North and Central London. NHS patients are seen at the RNOH Stanmore; private appointments can be booked on 07547 395 270 or by emailing secretary@matthewwelck.com.

10

Book a Consultation

If you have ongoing ankle pain — particularly after a sprain, fracture or sports injury that has not fully settled — specialist assessment can make a significant difference to your outcome. Early expert review gives you the widest range of treatment options and the best long-term result.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon, London & North London.

This page is for general information and does not replace individual medical advice.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 13 September 2026

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