Autologous osteoperiosteal transplantation from the iliac crest for the treatment of large osteochondral lesions of the talus.

PURPOSE: Autologous osteoperiosteal transplantation (AOPT) from the iliac crest has been proposed as a potential treatment for large osteochondral lesions of the talus (OLTs). This single-arm study aims to prospectively evaluate the clinical, radiological, and arthroscopic outcomes of AOPT from the iliac crest in patients with large cystic OLTs.

METHODS

This is a prospective single-arm study. We evaluated 42 patients who underwent AOPT from the iliac crest for OLTs. The mean follow-up was 32.5 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Tegner activity scores. Radiologic outcomes were evaluated via X-ray, CT, and MRI. Arthroscopy was performed on a subset of patients for second-look evaluation.

RESULTS

Significant clinical improvements were observed, with VAS scores decreasing from 4.36 ± 1.76 to 0.45 ± 0.63, AOFAS scores increasing from 75.38 ± 13.52 to 95.33 ± 4.81, and Tegner scores increasing from 2.00 ± 0.99 to 4.10 ± 1.10. Postoperative imaging revealed the resolution of subchondral radiolucency, improvement of articular surface protrusion or collapse, graft integration with surrounding bone, and a reduction in marrow oedema. Follow-up arthroscopy demonstrated significant lesion repair, with cartilage-like tissue integrated into the talus. No complications, including infections or donor-site morbidity, were observed.

CONCLUSION

AOPT from the iliac crest is associated with favourable short- to mid-term clinical, radiological, and arthroscopic outcomes, with no complications observed in this series. These findings provide prospective evidence supporting the potential of AOPT from the iliac crest as a treatment option for large talar osteochondral defects.