The Use of a Human Acellular Dermal Matrix (hADM) Transplant in Stage 4 Osteochondrosis Dissecans: A Retrospective Proof of Concept

Background: Osteochondral lesions (OD) of the talus represent a significant clinical challenge, particularly in advanced-stage cases requiring osteotomy access and cancellous bone grafting. Human acellular dermal matrix (hADM) has demonstrated promising biological properties—including biocompatibility, preserved extracellular matrix architecture, and neovascularization capacity—in reconstructive bone and soft tissue surgery. To our knowledge, its use as a defect-sealing membrane in osteochondral surgery of the talus has not previously been reported clinically. Methods: This retrospective case series evaluated six patients with stage 4 talar OD treated surgically using hADM as a defect-closing membrane in combination with malleolar osteotomy and autologous cancellous bone grafting. Clinical outcomes were assessed using the Foot and Ankle Disability Index (FADI) and FADI Sport score at a mean follow-up of 13 months (range 10–14 months). Predefined safety endpoints comprised local inflammatory reaction, material-related adverse events, wound-healing disturbance, union of the malleolar osteotomy, iliac crest donor-site morbidity and revision surgery. Results: Functional improvement was observed in all six patients. The mean FADI score rose from 31.2 (±7.8) to 96.5 (±14.1) points and the mean FADI Sport score from 4.0 (±5.2) to 27.8 (±9.2) points, corresponding to absolute gains of 65.3 and 23.8 points, respectively. Five of six patients (83.3%) reported complete resolution of symptoms. No revision of the cartilage reconstruction was required, and none of the predefined adverse events occurred. Conclusions: In this uncontrolled six-patient series, sealing the reconstructed defect with hADM was technically feasible and none of the predefined adverse events were observed within the reported follow-up. Because all patients additionally underwent debridement, malleolar osteotomy and autologous cancellous bone grafting, the functional gains cannot be attributed to the membrane itself. These preliminary observations are hypothesis-generating and support further prospective, controlled investigation of hADM as a defect-sealing material in osteochondral surgery.