Particulated autologous cartilage with platelet-rich plasma for osteochondral lesions of the talus in athletes: Return to sport and functional outcomes at 12 months.

BACKGROUND

Osteochondral lesions of the talus (OLT) are common in athletes and may compromise performance. Single-stage autologous cartilage procedures have emerged as alternatives to microfracture and osteochondral transplantation.

PURPOSE: To evaluate return-to-sport (RTS) outcomes and functional results after particulated autologous cartilage combined with platelet-rich plasma (PACI-PRP) in athletes with symptomatic OLT.

STUDY

DESIGN

Case series, Level IV.

METHODS

Fifty-three athletes (mean age 28.8 ± 11.4 years, 66% male) with symptomatic OLT >150 mm² underwent PACI-PRP via arthroscopy (83%) or arthrotomy with malleolar osteotomy (17%). Clinical outcomes (AOFAS, VAS, FADI, Karlsson) were assessed at 12 months. RTS metrics included time to return, competitive level achieved, and continuation at one year.

RESULTS

All scores improved significantly (p < 0.001): AOFAS 72→86 (+14 points), VAS 5.9→2.0 (-3.9 points), FADI 66→84 (+18 points), Karlsson 78→93 (+15 points). MCID achievement ranged from 75% to 94%. Forty-two of 52 athletes (81%, 95% CI: 68-90) returned to sport at median 32 weeks; 65% reached preinjury level. Four patients (8%) required reoperation for complications.

CONCLUSIONS

PACI-PRP demonstrated promising short-term effectiveness with high RTS rates and significant functional improvements in athletes with OLT >150 mm². As a single-stage, fully autologous procedure, PACI-PRP may offer potential advantages, though longer follow-up and comparative studies are needed to establish durability and precise indications.