Preliminary Clinical and Functional Outcomes After Combined Treatment of Lateral Osteochondral Lesions of the Talus and Chronic Ankle Instability Using Autologous Minced Cartilage and Retinaculum Flap Augmentation.

Background

Osteochondral lesions of the lateral talar shoulder (OLT) represent a significant therapeutic challenge, particularly when associated with chronic lateral ankle instability (CAI). While bone marrow stimulation is well established for talar lesions, clinical evidence on the minced cartilage technique (AutoCart™, Arthrex, Naples, FL, USA) in this specific localization remains limited. This study aimed to evaluate the short-term clinical and functional outcomes following combined treatment of lateral OLT and CAI using autologous minced cartilage and open ligament repair.

Methods

Nine patients (mean age: 39.8 years) with symptomatic lateral OLT and concomitant CAI were treated using the minced cartilage technique in conjunction with lateral ligament reconstruction. The mean defect size was 64.8 ± 30.2 mm2. Clinical and functional outcomes were assessed at a mean follow-up of 15.8 months using the Foot Function Index (FFI), Visual Analog Scale (VAS) for pain, return-to-sport status, and a motor-cognitive test (Skillcourt system). Postoperative complications and patient satisfaction were recorded.

Results

No postoperative complications occurred. All patients reported satisfaction with surgical outcomes. The mean postoperative FFI was 14.92 ± 12.74, indicating minimal functional limitations in daily life. Skillcourt testing revealed no significant side-to-side differences in most tests, except for the Single Leg Stability Test, which showed a significant deficit on the operated side (p = 0.027; Cohen's d = 0.9). Reduced dorsiflexion limited test performance of four patients. The average postoperative VAS during functional testing was 1.42 ± 1.62.

Conclusions

Combined treatment of lateral OLT and CAI using the minced cartilage technique and open ligament stabilization yields favorable short-term clinical and functional outcomes. Despite minor limitations in dorsiflexion, patients achieved high satisfaction rates and functional recovery. These preliminary findings support the technical feasibility and short-term clinical applicability of combining biological cartilage repair with mechanical stabilization for lateral talar lesions < 100 mm2. However, larger prospective studies with longer follow-ups are warranted to validate these findings.