Current systematic imaging analyses of osteochondral lesions of the distal tibial plafond (OLTP) remain insufficient. This study aimed to define the anatomical characteristics of OLTP using MRI to provide detailed morphological data that can guide diagnosis and inform surgical decision-making.

We retrospectively analyzed MRI data from 105 OLTP patients (mean age 47.88 ± 16.46 years; 51 males, 54 females). Anatomical parameters were measured, and statistical analyses were performed to compare results across different lesion zones, sexes, and laterality (left and right).

The anterolateral zone (Zone 3) and anterocentral zone (Zone 2) of the distal tibial plafond were the most frequently injured areas, accounting for 25.71 % and 24.76 % of cases, respectively. The central-medial zone (Zone 4) demonstrated the most severe lesions, with the lesion area in the sagittal view measuring 162.86 ± 91.95 mm² and the lesion area in the axial view reaching 213.07 ± 135.31 mm². Pairwise comparisons of anatomical parameters across specific injury zones showed statistically significant differences (P < 0.05) in the maximum width of the lesion in the sagittal view, the lesion area in the sagittal view, and the depth of osteochondral lesion with subchondral bone involvement. Furthermore, males had significantly greater cartilage thickness and deeper lesions than females (P < 0.05), with no significant laterality differences.

This study provides the first systematic anatomical map of OLTP, revealing significant regional variations in lesion distribution and sex-specific differences. These findings offer objective criteria to enhance diagnostic precision and guide personalized treatment.

Osteochondral lesions

Distal tibial plafond

Ankle joint injury

Imaging observation

Anatomical characteristics

Magnetic resonance imaging

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