Preoperative Computer Simulation and 3D-Printed Guide Plate of Autologous Transplantation Achieved Favorable Outcomes in Patients With Large Cystic Osteochondral Lesion of the Talus

Background: Autologous osteoperiosteal transplantation (AOPT) with osteotomy is an effective surgical treatment to large cystic osteochondral lesion of the talus (OLT), wherein osteoperiosteal grafts harvested from iliac crest are transplanted to osteochondral defects. However, operative complexity and high postoperative complication rate have emerged as key concerns. This study aims to design a customized AOPT preoperative planning and intraoperative navigation protocol to improve accuracy and efficiency. Methods: Medial cystic OLT patients with lesion area >100 mm 2 and/or depth >8 mm who underwent customized or conventional AOPT were identified from our database between May 2019 and June 2021. Surgical procedures were simulated and optimized on 3D reconstructed ankle models, and customized guide plates (cutting jigs) were designed to navigate osteotomy and bone socket creation intraoperatively. The MOCART, FAAM and VAS scores were recorded and compared. Postoperative complications were recorded. Results: 19 patients undergoing conventional and 13 patients receiving individualized AOPT were included. No significant difference was observed in OLT area (89.96 ± 28.23 mm² vs 87.85 ± 23.74 mm², P = .821). Postoperatively, the customized AOPT group had significantly lower VAS (2.00 [2.00-2.00] vs 3.00 [2.00-4.50], P = .004), significantly higher FAAM-ADL scores (mean difference, 5.75; 95% CI, 2.60-8.91, P < .001) and required significantly shorter surgery time (mean difference, −0.74 hours; 95% CI, −0.98 to −0.50, P < .001). Cyst recurrence was significantly reduced in the customized AOPT group (1/13 [7.69%] vs 9/19 [47.37%]; mean difference, −39.68%; 95% CI, −66.40% to −12.96%; P = .024). Osteotomy-site morbidity was lower but did not reach statistical significance (1/13 [7.69%] vs 8/19 [42.11%]; mean difference, −34.41%; 95% CI, −60.92% to −7.90%; P = .050). With the numbers available, no significant difference could be detected in FAAM-Sports or MOCART scores. Conclusion: In this retrospective comparative study, AOPT assisted by computer simulation and 3D printing was associated with improved clinical outcomes, shorter operative time, and fewer postoperative complications. These findings suggest that preoperative planning and patient-specific guidance may help standardize the execution of AOPT for complex medial large cystic OLTs. Given the limited sample size and non-randomized design, these results should be interpreted cautiously and warrant further validation in larger studies. Level of Evidence: Level III, retrospective cohort study.