All-Arthroscopic Autologous Cancellous Bone Transplantation Achieves Favorable Functional Improvements and Radiographic Recovery in Large Cystic Osteochondral Lesions of the Talus at a Minimum 12-Month Follow-Up.

PURPOSE: To evaluate short-term clinical and radiographic outcomes of all-arthroscopic autologous cancellous bone transplantation in addressing large cystic osteochondral lesions of the talus with cyst diameter ≥10 mm and cyst depth ≥6 mm.

METHODS

A retrospective analysis was carried out among consecutive patients who underwent arthroscopic cancellous bone transplantation by 1 senior surgeon between January 2020 and September 2023 using autografts from the ipsilateral Gerdy's tubercle. A minimum follow-up of 12 months was required for inclusion. Patient-reported outcome measures were evaluated preoperatively and at the latest follow-up, including the American Orthopaedic Foot & Ankle Society score, visual analogue scale, ankle activity score, and Foot and Ankle Outcome Score, with minimal clinically important difference analyzed of each scale. Subjective satisfaction was assessed with a 0-to-10 scale. Return-to-sports rate and representative sports level were recorded. The Magnetic Resonance Observation of Cartilage Repair Tissue score was evaluated based on postoperative magnetic resonance imaging.

RESULTS

Overall, 45 patients (45 ankles) were included. Mean follow-up duration was 27.6 ± 9.9 months (range, 14.7-48.0 months). Average diameter and depth of subchondral cysts were 13.5 ± 2.9 and 8.4 ± 1.6 mm. Patient-reported outcome measures were significantly improved: American Orthopaedic Foot & Ankle Society, from 53.9 ± 15.6 to 88.2 ± 9.8; visual analogue scale, from 7.9 ± 0.8 to 2.0 ± 1.0; ankle activity score, from 2.3 ± 1.1 to 4.0 ± 1.4; and Foot and Ankle Outcome Score, from 59.0 ± 7.8 to 83.1 ± 12.1 (P < .001 for all). Subjective satisfaction was 8.9 ± 1.1. Percentages of patients exceeding minimal clinically important differences of the American Orthopaedic Foot & Ankle Society, visual analogue scale, ankle activity score, and Foot and Ankle Outcome Score were 97.8%, 100.0%, 75.6%, and 88.9%, respectively. Return-to-sports rate was 64.5%, and 32.3% resumed preinjury level. The Magnetic Resonance Observation of Cartilage Repair Tissue score was 80.8 ± 12.0 at 19-month follow-up, with complete filling of the defects observed in 71.8% and complete integration in 79.5% patients.

CONCLUSIONS

In treatment of osteochondral lesions of the talus with large subchondral cysts, all-arthroscopic autologous cancellous bone transplantation showed favorable clinical and radiologic outcomes at a minimum 12-month follow-up, achieving significant improvements in patient-reported outcome measures and a mean Magnetic Resonance Observation of Cartilage Repair Tissue score of 80.8, although the return-to-sports rate remained modest at 64.5%.

LEVEL OF EVIDENCE: Level IV, retrospective case series.