Autologous Costal Cartilage Transplantation for Medial Osteochondral Lesions of the Talus

Background: Osteochondral lesions of the talus (OLT) are common and clinically challenging conditions with no consensus on how to optimally treat them. This prospective single-arm study aimed to evaluate the clinical outcomes of autologous costal cartilage transplantation (ACCT) for OLT. Methods: A prospective single-arm study of patients who were diagnosed with medial OLT and underwent ACCT with 2 years of follow-up was performed. There were 28 patients enrolled at a single center. The primary outcome was changes in American Orthopaedic Foot and Ankle Society (AOFAS) scores from baseline. The secondary outcomes included results of the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L) for quality of life, the visual analog scale for pain, the Tegner score for sports activity, and magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for imaging evaluations. Results: All 28 enrolled patients (41.82 ± 11.98 years, 9 female and 19 male) completed the initial study and the 2 years of follow-up. The AOFAS score improved significantly from 58.89 ± 8.74 preoperatively to 86.5 ± 7.41 at 1 year and 90.53 ± 5.49 at 2 years (p < 0.01 for both). EQ-5D-5L index improved from 0.866 ± 0.042 at baseline to 0.976 ± 0.041 at 2 years postoperatively (p < 0.01). Tegner score increased by 1.96 ± 0.69 at 2 years (p < 0.01). Patients reported significant pain relief at 2 years postoperatively (VAS: from 3.89 ± 0.87 to 0.75 ± 0.58, p < 0.01; EQ VAS: from 63.75 ± 6.02 to 88.57 ± 6.21, p < 0.01). The mean MOCART scores were 81.07 ± 11.25 at 6 months, 83.57 ± 11.85 at 1 year, and 82.32 ± 10.92 at 2 years. Complete filling of the defect was observed in all 28 patients at 2 years, and complete integration of the graft with the bone was seen in 25 cases (89.29%). Conclusions: ACCT for OLT led to significant improvement in clinical outcomes and effectively repaired talar osteochondral lesions, with grafts maintaining stability and integrating well with the host tissue over time. This study introduces ACCT as a novel strategy for OLT. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.