Cartilage-Sparing Management of Tibial Plafond OCLs Using Navigated Retrograde Drilling: Technique Outcomes and Review of Literature

Osteochondral lesions of the tibial plafond (OLTPs) are rare and pose significant treatment challenges, especially in cases of failed prior interventions such as subchondroplasty. Conventional surgical techniques may be limited by access constraints, lack of precision, and the risk of damaging the articular cartilage. We describe the case of a 44-year-old male police officer with a symptomatic posteromedial OLTP that persisted after posterior ankle arthroscopy and subchondroplasty. Preoperative imaging revealed a residual subchondral cyst despite prior cement augmentation. The patient underwent computer-assisted navigated retrograde drilling of the cystic lesion with allograft bone chips and bone marrow aspirate concentrate (BMAC) grafting, using intraoperative CT-based navigation. The procedure was completed successfully without violating the overlying cartilage. At 6 months postoperatively, the patient achieved complete resolution of pain, returned to unrestricted activity, and resumed running and occupational duties. The AOFAS Ankle-Hindfoot Score improved from 68 preoperatively to 100, while the Visual Analogue Scale (VAS) for pain reduced from 5 to 0. RAND-36 health survey results showed improvements in bodily pain, mental health, and general health perception. Postoperative MRI confirmed graft incorporation with adjacent marrow healing and a preserved joint surface. This case highlights that CT-navigated retrograde drilling with biological augmentation is a safe and effective technique for recurrent OLTPs, offering precise targeting and cartilage preservation with excellent radiologic and clinical outcomes. Level of Evidence Diagnostics level IV—retrospective case report, review article. See Instructions for Authors for a complete description of levels of evidence.