Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study
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Objective : To compare the clinical efficacy of autologous talar osteochondral transplantation (AOT) versus bone marrow stimulation (BMS) in the treatment of small focal osteochondral lesions of the talus (OLT). Methods : A retrospective analysis was conducted on 32 patients with OLT treated in our department from June 2018 to June 2023. Among them, 14 patients underwent AOT, and 18 received BMS. At 1-year postoperatively, CT and MRI were performed to assess functional recovery. Clinical outcomes were evaluated using the AOFAS-AH (American Orthopedic Foot & Ankle Society-Ankle Hindfoot) score, VAS (Visual Analogue Scale) score, and MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to comprehensively analyze limb function and cartilage repair. Quantitative data were expressed as mean ± standard deviation. Normally distributed data were compared using independent samples t-test, while non-normally distributed data were analyzed with the Mann-Whitney U test. Results : All patients were followed up for an average of 34.94 ± 12.66 months (range: 12–60 months). Postoperative imaging confirmed bony union in all cases, with no delayed union, nonunion, osteoarthritis, or donor-site complications. In the BMS group, the AOFAS-AH score improved from 60.39 ± 5.65 preoperatively to 79.50 ± 3.09 postoperatively, and the VAS score decreased from 3.44 ± 0.62 to 1.39 ± 0.50. In the AOT group, the AOFAS-AH score improved from 50.93 ± 6.12 to 88.64 ± 3.88, and the VAS score decreased from 5.57 ± 0.76 to 1.29 ± 0.47. The postoperative MOCART score was significantly higher in the AOT group (85.79 ± 2.49) compared to the BMS group (79.50 ± 3.09), with a statistically significant difference (P < 0.01). Conclusion : Both AOT and BMS yield favorable outcomes for small focal OLT, but AOT demonstrates superior therapeutic efficacy compared to BMS. Level of Evidence: Level III.
