Early Outcomes of Arthroscopic Microfracture Augmented with Autologous Platelet-Rich Fibrin for Osteochondral Lesions of the Talus

Background Osteochondral lesions of the talus (OLT) can cause persistent ankle pain and functional limitation. Microfracture is used to stimulate marrow-derived repair, while platelet-rich fibrin (PRF) has been proposed as a biologic scaffold that may enhance the local repair environment. Objective To describe the clinical and imaging characteristics of patients with OLT and to evaluate the early clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture combined with autologous PRF application. Methods This prospective observational case series included 18 patients aged ≥18 years with Hepple grade III-IV OLT who underwent ankle arthroscopy with microfracture and autologous PRF application at Viet Duc University Hospital between January 2025 and January 2026. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS). Preoperative MRI was classified according to the Hepple system, and postoperative MRI at 6 months was assessed using the MOCART 2.0 ankle score. Results The mean age was 37.67 ± 13.75 years (range, 18-60), and 77.78% of patients had a history of ankle trauma. Anteromedial lesions accounted for 88.89% of cases, and 77.78% were Hepple grade III. Mean AOFAS score improved from 53.22 ± 3.80 preoperatively to 82.83 ± 4.24 at 6 months (p<0.001), while mean VAS decreased from 5.22 ± 0.82 to 1.83 ± 1.07 (p<0.001). Mean follow-up was 11.82 ± 3.62 months. The mean postoperative MOCART 2.0 score was 76.0 ± 8.5 (range, 60-91). No vascular or nerve injury, wound infection, or ankle joint infection was reported. Conclusion In this 18-patient case series, arthroscopic microfracture combined with autologous PRF was associated with significant improvements in pain and ankle function during early follow-up. Postoperative MRI showed a mean MOCART 2.0 score of 76.0 ± 8.5. Larger controlled studies with longer follow-up are needed to determine the incremental benefit of PRF over microfracture alone.