Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus

Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus Hao Han, Qi Lu, Long Yang, Yaozhou Shi, Yuehua Hui, Rongjian Shi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8463516/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Purpose: The purpose of this study is to evaluate the clinical and radiological outcomes of arthroscopic autologous cancellous bone grafting combined with PRP injection in patients with osteochondral lesions of talus (OLT). Methods: This study was conducted at Xuzhou Renci Hospital from January 2020 to June 2023, including patients diagnosed with Hepple stage IV or V OLT by magnetic resonance imaging (MRI). Surgical interventions included debridement and microfracture under arthroscopy, autologous cancellous bone grafting, and PRP injection. Preoperative and postoperative assessments were performed using the visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, Kofoed score, and magnetic resonance observation of cartilage repair tissue (MOCART). Paired sample t-test was used for statistical analysis to compare data before and after surgery. Results: Twenty-one patients were enrolled, demonstrating significant postoperative improvements in VAS scores, AOFAS ankle-hindfoot scores, Kofoed scores (P < 0.05). Radiological examination showed good cartilage regeneration effects. No complications occurred in all patients, and no adverse reactions were observed at the donor knee site. Conclusion: Arthroscopic microfracture combined with autologous cancellous bone grafting and PRP injection is a promising technique for treating OLT, with good short-term outcomes and a high patient satisfaction rate, requiring further research for confirmation. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Osteochondral lesions of talus (OLT) is a common cartilage injury that can occur in up to 50% of acute ankle sprains and fractures, especially associated with sports injuries [ 1 – 2 ]. The typical clinical manifestations include chronic pain, swelling, stiffness, and mechanical symptoms of the ankle joint upon weight-bearing [ 3 ]. The secondary arthritis may occur in severe cases, which significantly impairing the patient's motor function and overall quality of life. Cases particularly classified as Hepple stage IV and subchondral cyst (Hepple stage V) often require surgical intervention. The purpose of surgical treatment is to relieve pain, restore normal function, and reconstruct the subchondral bone stent [ 4 ]. Surgical treatment techniques are diverse and can be broadly categorized into reconstructive techniques and restorative techniques. Restorative techniques include cancellous bone grafting, autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, autologous or allogeneic bone-joint transplantation, or vascularized osteochondral transplantation [ 5 – 6 ]. These techniques typically involve ankle osteotomy or wedge osteotomy, which disrupts normal bone anatomy and compromises the blood supply around the talus. This is associated with complications such as intraoperative cartilage damage, malunion or nonunion, chronic pain, and secondary osteoarthritis [ 7 ]. Reparative techniques include osteochondral stimulation surgery, arthroscopic microfracture, autologous matrix-induced chondrogenesis, arthroscopic debridement, internal fixation of fragments, and intramedullary stimulation techniques. Debridement and subchondral bone microfracture are the most described surgical procedure [ 8 – 9 ]. Despite the advantages of minimal invasiveness, rapid postoperative recovery, and fewer complications, the long-term effects of this technique are limited. Platelet-rich plasma (PRP) contains a high concentration of platelets, which include and release various growth factors, promoting chondrocyte proliferation, differentiation, and matrix synthesis [ 10 ]. PRP has achieved positive clinical results in the treatment of knee osteochondral lesions or osteoarthritis (OA) [ 11 ]. The present study analyzed a surgical technique for OLTs that combines arthroscopic debridement with microfracture, cancellous bone grafting, and PRP injection procedure. Methods 2.1 Study design This study was performed in accordance with the STROBE statement. A retrospective, consecutive case series design was employed, supplemented by follow-up investigations. All 21 cases between January 2020 and June 2023 were screened for eligibility. A total of 21 patients who met the inclusion criteria and agreed to participate, were conducted clinical and radiological follow-up, and were eventually included into our study. Written informed consent was obtained from these patients. All patients were reported at least one ankle sprain to the affected ankle. This study has been approved by the Ethics Committee of Xuzhou Renci Hospital (ID: XZRCLL-LW-202011001) and complies with the requirements of the Declaration of Helsinki. All patients have provided informed consent and signed the informed consent forms. 2.2 Inclusion and exclusion criteria Inclusion criteria: (1) Chronic ankle pain has been ineffective after systematic conservative treatment for more than 6 months; (2) Preoperative MRI examination diagnosed as talus osteochondral lesion, staged as Hepple IV-V; (3) The surgical method is arthroscopic microfracture, autologous cancellous bone grafting combined with PRP injection; (4) Regular follow-up for more than one year after surgery and re-examination of MRI. Exclusion Criteria: (1) concomitant ankle osteoarthritis, rheumatoid arthritis, or gouty arthritis; (2) concomitant foot bone deformities, soft tissue deformities, or lower limb alignment abnormalities; (3) infection, tumors, severe immune system disorders, coagulation disorders, or bleeding disorders; (4) cases converted to open surgery during the procedure; (5) previous operative treatment of the affected ankle. 2.3 Surgical technique The location and depth of talar cartilage lesions were determined through magnetic resonance imaging (MRI) and CT (Fig. 1 ), and the surgical plan was formulated accordingly, with anterior or posterior arthroscopic approach. All patients underwent general anesthesia or intra-spinal anesthesia. A tourniquet was used on the thigh of the same side. The patient's foot was pulled at a certain angle towards the outer edge of the operating table to fully allow for plantar flexion and dorsiflexion of the ankle joint. 2.3.1 Diagnostic arthroscopy, debridement, and microfracture. All surgeries were performed by a highly experienced senior orthopedic surgeon specialized in sports medicine. Standard disinfection procedures were followed, and a tourniquet were applied for hemostasis. A 4.0 mm, 30° arthroscope (CONMED, Utica, NY) was used for ankle diagnosis and treatment. First, a diagnostic ankle arthroscopy was performed. Talus osteochondral lesions could be better revealed by forcing the ankle into plantar flexion under anterior arthroscopy or by entering dorsiflexion under posterior ankle arthroscopy. Any potential pathologies were thoroughly examined and assessed such as articular cartilage, ligaments, bone spurs, or synovial tissue. A chisel was used to release the adhesions of the proliferative synovium, and removed bone spurs and loose bodies. A chisel was used to release the adhesions of the proliferative synovium, and bone spurs and loose bodies were removed. If a component of the deltoid ligament or the lateral collateral ligament was ruptured, a ligament reconstruction surgery was performed simultaneously. The initial treatment for OLT was consisted of thorough curettage and debridement of unstable cartilage and osteochondral tissue. All superficial cartilage, cystic components, and necrotic bone defects were debrided under arthroscopy with a curette until the intact subchondral bone is exposed and forms a 90° angle with the surrounding cartilage wall. The size of the lesion, including its diameter and depth, was further confirmed by measurements using a probe under arthroscopy. A microfracture cones were used to establish a 5mm deep subchondral channel at the bottom and side walls of the cartilage defect area, with a spacing of 3-5mm between channels (Fig. 2 ). 2.3.2 Harvesting and transplantation of autologous cancellous bone The ipsilateral proximal tibia Gerdy's tubercle was chosen as the donor site for cancellous bone collection. After carefully palpating Gerdy's tubercle, a 3-cm longitudinal incision was made through the skin, subcutaneous tissue, and deep fascia. A 10-mm-long cylindrical bone sample was harvested from the Gerdy's tubercle using a bone harvest tube of appropriate diameter (8 or 10 mm). The autologous cancellous bone below was collected using a curette, and the cylindrical bone was used to fill the defect area of the Gerdy tubercle (Fig. 3 ). A dry arthroscopy technique was used during the implantation of autologous cancellous bone, and a shaver aspirator was employed to aspirate the intra-articular fluid. The prepared cancellous bone was accurately pushed and placed into the lesion through a specially designed delivery guiding device. The graft was injected into the defect area with the help of the scraper and probe until a flat cartilage surface is maintained, even at the level of the subchondral bone. After several cycles of ankle extension and flexion, verified that the cancellous bone graft was securely fixed in the defect site (Fig. 4 , A-C). 2.3.3 Preparation and injection of PRP Prepare PRP using the platelet separation system according to the system instructions. A total of 70 mL of venous blood was drawn from each patient in this group, mixed with 5 milliliters of sodium citrate for anticoagulation. The total solution of 50mL was centrifuged at 4°C, 3000r/min for 10min. At the end of the procedure, 5mL PRP was obtained. During the procedure, 1ml of saline combined with 1000U of thrombin was used to prepare thrombin-activated PRP, which was injected into the lesion site after the PRP solidified into a gel-like consistency. We recommend that patients perform ankle flexion and extension exercises to evenly distribute the PRP solution (Fig. 4 , D-F). 2.4 Postoperative management and rehabilitation protocol After the patients return to the ward, the affected limb should be elevated and ice applied to reduce swelling and pain. Prophylactic use of antibiotics, anti-swelling and analgesic medications, nutritional support, and symptomatic treatment to prevent stress ulcers. A protective rehabilitation regimen was implemented for the initial 6 weeks, with continuous passive motion (CPM) exercises for the ankle joint commencing 48 hours postoperatively and continuing for 6 weeks. As the patient recovered to the maximum achievable range of motion, the frequency and duration of passive activities were gradually increased. Partial weight bearing was started after 6 weeks. Full weight bearing was allowed at 8 to 10 weeks. Patients typically regain full range of motion within 12 weeks after surgery, enhancing the stability of muscles and the ankle joint through proprioceptive training. 2.5 Observation indicators and efficacy evaluation Postoperative outpatient follow-up examinations were scheduled at 6 weeks, 3 months, 6 months, and 1 year. CT or MRI scans would be performed to assess talar cartilage recovery, and subjective symptom improvement and pain during walking would be documented. The patient's visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Kofoed score for the ankle joint were recorded. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to evaluate the recovery of talar cartilage lesions (Fig. 5 ). 2.6 Statistical analysis Statistical analysis was performed using SPSS version 25.0 software. The Shapiro-Wilk test was used to assess the normality of the data, the quantitative data that conforms to the normal distribution is expressed as mean ± standard deviation. The quantitative data of the last follow-up before and after the operation were compared using paired sample t-test. Non-normally distributed measurement data were expressed as M (IQR) and analyzed using non-parametric tests. Results 3.1 Demographic data This study included a total of 21 patients: 13 males and 8 females, with an average age of 49.8 ± 10.2 years (29–67 years) at the time of surgery. All patients presented with unilateral talus cartilage injury, with 12 cases located in the right ankle and 9 cases in the left ankle. The lesions were classified according to the Hepple classification system: type IV in 12 cases and type V in 9 cases. The preoperative average body mass index was 25.3 ± 2.5 kg/m 2 (19.1 ~ 26.3 kg/m 2 ), and the time from injury to surgery was 12.4 ± 5.5 months (4–26 months) (Table 1 ). Table 1 The clinical and demographic characteristics of 21 patients Characteristic Mean or n Average age (y) 49.8 ± 10.2 Sex (male/female) 13/8 Average BMI (kg/m 2 ) 25.3 ± 2.5 Disease course (month) 12.4 ± 5.5 Location (left / right) 9/12 Hepple stage IV 12 Hepple stage V 9 BMI: body mass index 3.2 Clinical efficacy and imaging evaluation before and after surgery. All patients successfully completed the surgery and followed up for more than 12 months. At the last follow-up, VAS, AOFAS, and Kofoed scores showed significant improvement compared to preoperative levels, with statistically significant differences (all P < 0.001, Table 2 ). Evaluate the ankle function at the last follow-up based on the AOFAS score, with 12 cases rated as excellent, 9 cases rated as good, and an excellent-good rate of 100% (21/21). Based on the Kofoed score, evaluate the ankle function at the last follow-up, with 16 cases rated as excellent, 5 cases rated as good, and an excellent-good rate of 100% (21/21). At the last follow-up, the MOCART score was 69.1 ± 10.4 (53–89). No complications such as wound infection, necrosis, vascular nerve injury, and donor site pain occurred in all patients after surgery. Table 2 Clinical and radiological outcome scores at preoperative and final follow-up Items Preoperative Final Follow-up t P value VAS 6(1) 1(0.5) 4.06 < 0.001 AOFAS 63.2 ± 9.8 89.3 ± 5.5 9.90 < 0.001 Kofoed 28.4 ± 8.8 89.1 ± 5.2 25.89 < 0.001 Discussion The talus can be anatomically divided into three distinct regions: head, neck, and body, with most of its surface covered by articular cartilage. This cartilage tissue is avascular and lacks neural nourishment, and as a bone without muscle attachment, its nutrition mainly relies on synovial fluid. These factors collectively lead to the difficulty in achieving effective self-repair after injury [ 12 ]. OLT is a common cause of ankle pain and dysfunction, and severe cartilage injuries (Hepple IV-V type) with subchondral cyst formation often require surgical intervention [ 5 , 13 ]. There are numerous surgical methods for OLT and their efficacy remains controversial. Bone marrow stimulation (BMS) is the gold standard for treating OLT [ 14 ], primarily indicated for lesions with an area of < 1.5 cm² and a depth of < 5 mm [ 15 ]. However, the fibrocartilage regenerated by microfractures is mainly composed of Type I collagen, which has significant biological differences compared to the Type II collagen that constitutes the normal cartilage of the talus. The elasticity and wear resistance of fibrocartilage are inferior to that of normal cartilage, making it more denaturation to degeneration under shear stress [ 16 – 17 ]. Researchers have found that the cartilage repair scores observed during secondary arthroscopy examination after BMS were significantly lower than those of cartilage transplantation or retrograde drilling, with 36% of lesions remained incompletely healed [ 18 ]. PRP is rich in growth factors, fibrinogen, and various bioactive substances, which can promote the repair of damaged cartilage tissue [ 19 – 20 ]. This study demonstrates that full-arthroscopic cancellous bone grafting combined with PRP injection for the treatment of OLT can effectively repair cartilage injury, while simultaneously alleviating pain in the affected limb and improving ankle joint function, with satisfactory short-term efficacy. It is usually required to perform osteotomy of the medial or lateral malleolus to adequately expose the lesion area due to the intricate anatomical structure of the ankle joint, [ 21 ], which disrupts the normal anatomical structure and damages the blood supply around the talus. At the same time, there are complications such as intraoperative cartilage iatrogenic injury, delayed healing or non-healing of the osteotomy site, chronic pain or swelling, and the need for secondary surgery to remove internal fixation devices [ 22 ]. The advantages of traditional open surgery in providing a surgical field for OLT can now be achieved through arthroscopic procedures. Arthroscopic cancellous bone grafting for OLT has been demonstrated to significantly reduce pain and restore ankle joint function [ 23 – 24 ]. In present study, we observed the lesion area and performed bone graft through arthroscopy, whose primary advantages include: (1) performs through a small incision, reducing surgical trauma and protecting the blood supply of local tissues, thereby palliate postoperative pain and inflammatory response, promoting early activity and functional recovery; (2) minimizes complications commonly associated with open osteotomy procedures, shortens hospital stays, and accelerates recovery; (3) eliminates the need for internal fixation devices and intraoperative fluoroscopy, reducing radiation exposure for both patients and medical staff, and avoids the necessity for secondary surgeries to remove internal fixators. Cancellous bone possesses numerous trabecular spaces and a soft texture, which can adapt to the shape of the damaged area and provide effective structural support, facilitating the growth of blood vessels and fibrous tissue, and helping to restore the bone integrity and function [ 7 , 25 – 26 ]. Regarding the harvest of cancellous bone, previous literature has reported that the iliac crest, distal tibia, and the ankle bone itself are common donor sites [ 23 , 27 ]. The iliac crest has demonstrated favorable outcomes in reducing donor site complications and is one of the frequently utilized transplantation sites. In this study, selection of the ipsilateral tibial Gerdy tubercle for obtaining cancellous bone has the following two major advantages: (1) There is no need to enlarge the surgical disinfection area. (2) The Gerdy tubercle is far from the joint surface, thereby minimizing the risk of damage to the articular cartilage surface [ 28 ]. In terms of our experience with cancellous bone transplantation: first, the cancellous bone is placed into the defect area and compacted through the bone graft sleeve, while PRP is applied to the surface of the cancellous bone and the effect of gravity can further prevent autologous cancellous bone displacement. A study by Rikken reported on arthroscopic BMS for OLT with at least 8 years of follow-up, and approximately 1/3 of the patients showed progressive cartilage degeneration on imaging, with even the risk of developing end-stage ankle arthritis [ 16 ]. A randomized controlled trial (RCT) study on PRP demonstrated that PRP injection after microfracture achieved superior mid-term outcomes compared to hyaluronic acid [ 29 ]. The meta-analysis by Woo et al. included 235 patients with OLT, and the results showed that the effect of the ankle arthroscopy microfracture combined with PRP group was significantly better than that of the simple microfracture or combined with other biological agents [ 20 ]. In this study, we achieved precise targeted injections under arthroscopic monitoring, with PRP and thrombin prepared into a gel that firmly adheres to the cartilage defect area, which is beneficial for better repair of OLT. The MOCART score was 69.1 ± 10.4 at 1-year follow-up, which is higher than the treatment effect of simple microfracture reported in previous studies [ 30 – 31 ], indicating that PRP injection can compensate for the inherent limitations of microfracture surgery and promote the cartilage repair and integration. This study also has some limitations. Firstly, it is a retrospective study with a small sample size and a short follow-up period, lacking comparison with other commonly surgical approaches. Secondly, medical ethics limited postoperative secondary arthroscopic evaluation of cartilage recovery. It is necessary to conduct multi-center, large-sample, long-term follow-up studies to evaluate and verify clinical effects and complications. In summary, full-arthroscopic cancellous bone grafting combined with PRP injection for the treatment of severe OLT can reduce pain in the affected limb, improve ankle joint function, and effectively repair cartilage injury, demonstrating satisfactory short-term efficacy. Declarations Ethics approval and consent to participate ： This study has been approved by the Ethics Committee of Xuzhou Renci Hospital (ID: XZRCLL-LW-202011001) and complies with the requirements of the Declaration of Helsinki. All patients have provided informed consent and signed the informed consent forms. Consent for publication: The study has obtained informed consent from all participants. Availability of data and materials: The data with article can be obtained from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no relevant financial or non-financial interests to disclose. Funding: This work was supported by the “Scientific Research Surface Project of Jiangsu Provincial Healthcare Commission (Grant No. H2019023) and General Science and Technology Project of Xuzhou Municipal Health Commission (Grant No. XWKYHT20240039) Author Contributions: Hao Han, Qi Lu: Conceptualization and study design, statistical analysis and manuscript drafting; Long Yang, Yaozhou Shi: Patient data follow-up and collection Yuehua Hui: Postoperative care guidelines Rongjian Shi, Qinwei Guo: Surgical procedures instruction Jie Li and Guangchao Cao: Manuscript review, research guidance and funding support Acknowledgements: We appreciate the guidance and strong support from department leaders and colleagues throughout this research project and manuscript collaboration. Authors details Hao Han 1, 3 , Qi Lu 1 , Long Yang 1 ，Yaozhou Shi 1 , Yuehua Hui 1 , Rongjian Shi 1 , Qinwei Guo 2 ，Jie Li 3 ，Guangchao Cao 1* 1. Department of Foot and Ankle Surgery, Xuzhou Renci Hospital, Xuzhou 221000, Jiang Su, China 2. Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China 3. Department of Orthopaedic, Xuzhou Central Hospital Affiliated to Southeast University, Xu Zhou 221000, Jiang Su, China * Corresponding author: Guangchao Cao Correspondence E-mail: [email protected] References Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21:119-126. http://dx.doi.org/10.1177/107110070002100205 Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ (2017) Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 8:19-30. http://dx.doi.org/10.1177/1947603516670708 Grambart ST, Passet A, Holte N (2023) Osteochondral Lesions of the Talus: The Questions We Would Like Answered. 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Arthrosc Tech 14:103208. http://dx.doi.org/10.1016/j.eats.2024.103208 Görmeli G, Karakaplan M, Görmeli CA, Sarıkaya B, Elmalı N, Ersoy Y (2015) Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Foot Ankle Int 36:891-900. http://dx.doi.org/10.1177/1071100715578435 Drakos MC, Eble SK, Cabe TN, Patel K, Hansen OB, Sofka C, Fabricant PD, Deland JT (2021) Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture. Foot Ankle Int 42:841-850. http://dx.doi.org/10.1177/1071100720983266 Lee YK, Young KW, Kim JS, Lee HS, Cho WJ, Kim HN (2020) Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial. BMC Musculoskelet Disord 21:716. http://dx.doi.org/10.1186/s12891-020-03730-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Apr, 2026 Reviews received at journal 03 Apr, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 23 Jan, 2026 Editor assigned by journal 20 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 27 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8463516","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580602955,"identity":"87fdf9d6-3c05-4159-849c-178a6a20e048","order_by":0,"name":"Hao Han","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Han","suffix":""},{"id":580602956,"identity":"38e1deae-944e-46d9-8ccf-cb64c9e1c563","order_by":1,"name":"Qi Lu","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Lu","suffix":""},{"id":580602957,"identity":"7d5329b6-680e-46f7-9295-72c41602db94","order_by":2,"name":"Long Yang","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Long","middleName":"","lastName":"Yang","suffix":""},{"id":580602958,"identity":"6d0a1281-22f5-4b34-854c-9d4bd080fbe4","order_by":3,"name":"Yaozhou Shi","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yaozhou","middleName":"","lastName":"Shi","suffix":""},{"id":580602959,"identity":"087f81b2-184f-411c-b229-b83dfcbc2397","order_by":4,"name":"Yuehua Hui","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuehua","middleName":"","lastName":"Hui","suffix":""},{"id":580602960,"identity":"956b271e-de02-4a65-8791-670015675b6b","order_by":5,"name":"Rongjian Shi","email":"","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rongjian","middleName":"","lastName":"Shi","suffix":""},{"id":580602961,"identity":"650bcb6a-2866-433d-a5cf-0a3e0d5de35c","order_by":6,"name":"Qinwei Guo","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qinwei","middleName":"","lastName":"Guo","suffix":""},{"id":580602962,"identity":"4c4a352d-1228-46cd-8fb7-38938a02ae45","order_by":7,"name":"Jie Li","email":"","orcid":"","institution":"Xuzhou Central Hospital Affiliated to Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Li","suffix":""},{"id":580602963,"identity":"46947095-6078-4cb7-92e1-33069eba2583","order_by":8,"name":"Guangchao Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYNACgwNAgrHxQcIPiXp+ZubDD4jUwnzY4GOPTYJkO1uaARHWgLSwpUnOYEtLMDjPoyCBTy1/++Fjn3kK7siZ868xNubhOZxnfJiHwYChxiYalxaJM2nJs3kMnhlbznhj+JjH4nCx2WHeAw8YjqXlNuDyBUOOMTOPweHEDTfOgG1h3HaYL8GAseEwbi38b8Ba6oFazKR52A4zbm7mMZDAq0UCYgvQ121g7yduYCagReLGs2TGOQaHDTfcgASyscRhYCAn4PELf3/yYYY3fw7LG5w/CI5KOf7+w4cffKixwakFyb4EJE4CDkVo9h0gStkoGAWjYBSMQAAApjlfFvN4pn4AAAAASUVORK5CYII=","orcid":"","institution":"Xuzhou Renci Hospital","correspondingAuthor":true,"prefix":"","firstName":"Guangchao","middleName":"","lastName":"Cao","suffix":""}],"badges":[],"createdAt":"2025-12-28 01:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8463516/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8463516/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101363436,"identity":"55e8b880-e942-4101-b9a1-eb172326ff4e","added_by":"auto","created_at":"2026-01-29 00:36:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":434941,"visible":true,"origin":"","legend":"\u003cp\u003eA 67-year-old male patient, preoperative ankle joint CT and MRI showed a large cystic lesion.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/730a552ba70c865686a655b0.png"},{"id":101363431,"identity":"30d3e4a0-b3ea-4a30-a5bd-6c788390161a","added_by":"auto","created_at":"2026-01-29 00:36:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":922927,"visible":true,"origin":"","legend":"\u003cp\u003eA-B: The joint arthroscopy assessment and examination was performed on the osteochondral lesions of the posterior medial surface of the talus. C: The arthroscopic curette was used to debride the defective cartilage and subchondral tissue, and a probe was used to reassess and measure the defect. D: Microfracture cones were used to create holes in the subchondral bone and bone marrow stimulation was applied.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/50baba21b3a0304a64ae46db.png"},{"id":101363434,"identity":"f306290a-06e8-4e1c-a886-ea82c94092f8","added_by":"auto","created_at":"2026-01-29 00:36:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1122603,"visible":true,"origin":"","legend":"\u003cp\u003eA: Harvesting of autologous cancellous bone from the Gerdy tubercle in the right knee. B: The appearance of a cylindrical bone column collected using a collection tube at an appropriate depth of about 10 millimeters. C: The previously harvested cylindrical bone block was replanted back to its original position to maintain the integrity of the tibia. D: The overall appearance of the harvested autologous cancellous bone.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/c5dcdcc8ef38448fce9bdf10.png"},{"id":101363433,"identity":"474da6d8-4c3e-41d8-b872-a02d31f1e7b9","added_by":"auto","created_at":"2026-01-29 00:36:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":928656,"visible":true,"origin":"","legend":"\u003cp\u003eA-C: Using arthroscopic technology, the prepared graft is pressed into the defect lesion area through the delivery guidance device. D: Preoperatively centrifuged and collected PRP. E: The prepared PRP gel is injected into the defect site under arthroscopy. F: Postoperative appearance of the surgical area.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/5f907a20c8bde1dd93f8b81b.png"},{"id":101397963,"identity":"79a5d255-9458-4539-884a-9d84dc78db06","added_by":"auto","created_at":"2026-01-29 09:38:27","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":735600,"visible":true,"origin":"","legend":"\u003cp\u003eA-C: The CT examination showed good filling of the defect area with cancellous bone on 1 month after surgery. D-F: At 6 months postoperative, the MRI revealed partial recovery of the talar articular surface. G-I: 1 year postoperative MRI demonstrated good integration of cancellous bone with surrounding tissues, and the ankle articular cartilage surface appeared smooth.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/7a040a0e1465fa51a484bccd.png"},{"id":102294960,"identity":"4472d8ad-c803-4be0-9cee-32db83c0e3c9","added_by":"auto","created_at":"2026-02-10 10:05:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6122594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8463516/v1/d2208310-37bb-42f9-927d-b068223e96ba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteochondral lesions of talus (OLT) is a common cartilage injury that can occur in up to 50% of acute ankle sprains and fractures, especially associated with sports injuries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The typical clinical manifestations include chronic pain, swelling, stiffness, and mechanical symptoms of the ankle joint upon weight-bearing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The secondary arthritis may occur in severe cases, which significantly impairing the patient's motor function and overall quality of life. Cases particularly classified as Hepple stage IV and subchondral cyst (Hepple stage V) often require surgical intervention. The purpose of surgical treatment is to relieve pain, restore normal function, and reconstruct the subchondral bone stent [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical treatment techniques are diverse and can be broadly categorized into reconstructive techniques and restorative techniques. Restorative techniques include cancellous bone grafting, autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, autologous or allogeneic bone-joint transplantation, or vascularized osteochondral transplantation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These techniques typically involve ankle osteotomy or wedge osteotomy, which disrupts normal bone anatomy and compromises the blood supply around the talus. This is associated with complications such as intraoperative cartilage damage, malunion or nonunion, chronic pain, and secondary osteoarthritis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Reparative techniques include osteochondral stimulation surgery, arthroscopic microfracture, autologous matrix-induced chondrogenesis, arthroscopic debridement, internal fixation of fragments, and intramedullary stimulation techniques. Debridement and subchondral bone microfracture are the most described surgical procedure [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite the advantages of minimal invasiveness, rapid postoperative recovery, and fewer complications, the long-term effects of this technique are limited. Platelet-rich plasma (PRP) contains a high concentration of platelets, which include and release various growth factors, promoting chondrocyte proliferation, differentiation, and matrix synthesis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. PRP has achieved positive clinical results in the treatment of knee osteochondral lesions or osteoarthritis (OA) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The present study analyzed a surgical technique for OLTs that combines arthroscopic debridement with microfracture, cancellous bone grafting, and PRP injection procedure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis study was performed in accordance with the STROBE statement. A retrospective, consecutive case series design was employed, supplemented by follow-up investigations. All 21 cases between January 2020 and June 2023 were screened for eligibility. A total of 21 patients who met the inclusion criteria and agreed to participate, were conducted clinical and radiological follow-up, and were eventually included into our study. Written informed consent was obtained from these patients. All patients were reported at least one ankle sprain to the affected ankle. This study has been approved by the Ethics Committee of Xuzhou Renci Hospital (ID: XZRCLL-LW-202011001) and complies with the requirements of the Declaration of Helsinki. All patients have provided informed consent and signed the informed consent forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eInclusion criteria: (1) Chronic ankle pain has been ineffective after systematic conservative treatment for more than 6 months; (2) Preoperative MRI examination diagnosed as talus osteochondral lesion, staged as Hepple IV-V; (3) The surgical method is arthroscopic microfracture, autologous cancellous bone grafting combined with PRP injection; (4) Regular follow-up for more than one year after surgery and re-examination of MRI. Exclusion Criteria: (1) concomitant ankle osteoarthritis, rheumatoid arthritis, or gouty arthritis; (2) concomitant foot bone deformities, soft tissue deformities, or lower limb alignment abnormalities; (3) infection, tumors, severe immune system disorders, coagulation disorders, or bleeding disorders; (4) cases converted to open surgery during the procedure; (5) previous operative treatment of the affected ankle.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Surgical technique\u003c/h2\u003e \u003cp\u003eThe location and depth of talar cartilage lesions were determined through magnetic resonance imaging (MRI) and CT (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and the surgical plan was formulated accordingly, with anterior or posterior arthroscopic approach. All patients underwent general anesthesia or intra-spinal anesthesia. A tourniquet was used on the thigh of the same side. The patient's foot was pulled at a certain angle towards the outer edge of the operating table to fully allow for plantar flexion and dorsiflexion of the ankle joint.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Diagnostic arthroscopy, debridement, and microfracture.\u003c/h2\u003e \u003cp\u003eAll surgeries were performed by a highly experienced senior orthopedic surgeon specialized in sports medicine. Standard disinfection procedures were followed, and a tourniquet were applied for hemostasis. A 4.0 mm, 30\u0026deg; arthroscope (CONMED, Utica, NY) was used for ankle diagnosis and treatment. First, a diagnostic ankle arthroscopy was performed. Talus osteochondral lesions could be better revealed by forcing the ankle into plantar flexion under anterior arthroscopy or by entering dorsiflexion under posterior ankle arthroscopy. Any potential pathologies were thoroughly examined and assessed such as articular cartilage, ligaments, bone spurs, or synovial tissue. A chisel was used to release the adhesions of the proliferative synovium, and removed bone spurs and loose bodies. A chisel was used to release the adhesions of the proliferative synovium, and bone spurs and loose bodies were removed. If a component of the deltoid ligament or the lateral collateral ligament was ruptured, a ligament reconstruction surgery was performed simultaneously. The initial treatment for OLT was consisted of thorough curettage and debridement of unstable cartilage and osteochondral tissue. All superficial cartilage, cystic components, and necrotic bone defects were debrided under arthroscopy with a curette until the intact subchondral bone is exposed and forms a 90\u0026deg; angle with the surrounding cartilage wall. The size of the lesion, including its diameter and depth, was further confirmed by measurements using a probe under arthroscopy. A microfracture cones were used to establish a 5mm deep subchondral channel at the bottom and side walls of the cartilage defect area, with a spacing of 3-5mm between channels (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Harvesting and transplantation of autologous cancellous bone\u003c/h2\u003e \u003cp\u003eThe ipsilateral proximal tibia Gerdy's tubercle was chosen as the donor site for cancellous bone collection. After carefully palpating Gerdy's tubercle, a 3-cm longitudinal incision was made through the skin, subcutaneous tissue, and deep fascia. A 10-mm-long cylindrical bone sample was harvested from the Gerdy's tubercle using a bone harvest tube of appropriate diameter (8 or 10 mm). The autologous cancellous bone below was collected using a curette, and the cylindrical bone was used to fill the defect area of the Gerdy tubercle (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A dry arthroscopy technique was used during the implantation of autologous cancellous bone, and a shaver aspirator was employed to aspirate the intra-articular fluid. The prepared cancellous bone was accurately pushed and placed into the lesion through a specially designed delivery guiding device. The graft was injected into the defect area with the help of the scraper and probe until a flat cartilage surface is maintained, even at the level of the subchondral bone. After several cycles of ankle extension and flexion, verified that the cancellous bone graft was securely fixed in the defect site (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, A-C).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Preparation and injection of PRP\u003c/h2\u003e \u003cp\u003ePrepare PRP using the platelet separation system according to the system instructions. A total of 70 mL of venous blood was drawn from each patient in this group, mixed with 5 milliliters of sodium citrate for anticoagulation. The total solution of 50mL was centrifuged at 4\u0026deg;C, 3000r/min for 10min. At the end of the procedure, 5mL PRP was obtained. During the procedure, 1ml of saline combined with 1000U of thrombin was used to prepare thrombin-activated PRP, which was injected into the lesion site after the PRP solidified into a gel-like consistency. We recommend that patients perform ankle flexion and extension exercises to evenly distribute the PRP solution (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, D-F).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Postoperative management and rehabilitation protocol\u003c/h2\u003e \u003cp\u003eAfter the patients return to the ward, the affected limb should be elevated and ice applied to reduce swelling and pain. Prophylactic use of antibiotics, anti-swelling and analgesic medications, nutritional support, and symptomatic treatment to prevent stress ulcers. A protective rehabilitation regimen was implemented for the initial 6 weeks, with continuous passive motion (CPM) exercises for the ankle joint commencing 48 hours postoperatively and continuing for 6 weeks. As the patient recovered to the maximum achievable range of motion, the frequency and duration of passive activities were gradually increased. Partial weight bearing was started after 6 weeks. Full weight bearing was allowed at 8 to 10 weeks. Patients typically regain full range of motion within 12 weeks after surgery, enhancing the stability of muscles and the ankle joint through proprioceptive training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Observation indicators and efficacy evaluation\u003c/h2\u003e \u003cp\u003ePostoperative outpatient follow-up examinations were scheduled at 6 weeks, 3 months, 6 months, and 1 year. CT or MRI scans would be performed to assess talar cartilage recovery, and subjective symptom improvement and pain during walking would be documented. The patient's visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Kofoed score for the ankle joint were recorded. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to evaluate the recovery of talar cartilage lesions (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS version 25.0 software. The Shapiro-Wilk test was used to assess the normality of the data, the quantitative data that conforms to the normal distribution is expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The quantitative data of the last follow-up before and after the operation were compared using paired sample t-test. Non-normally distributed measurement data were expressed as M (IQR) and analyzed using non-parametric tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic data\u003c/h2\u003e \u003cp\u003eThis study included a total of 21 patients: 13 males and 8 females, with an average age of 49.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 years (29\u0026ndash;67 years) at the time of surgery. All patients presented with unilateral talus cartilage injury, with 12 cases located in the right ankle and 9 cases in the left ankle. The lesions were classified according to the Hepple classification system: type IV in 12 cases and type V in 9 cases. The preoperative average body mass index was 25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 kg/m\u003csup\u003e2\u003c/sup\u003e (19.1\u0026thinsp;~\u0026thinsp;26.3 kg/m\u003csup\u003e2\u003c/sup\u003e), and the time from injury to surgery was 12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 months (4\u0026ndash;26 months) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe clinical and demographic characteristics of 21 patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean or n\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage age (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13/8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage BMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease course (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation (left / right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepple stage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepple stage V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI: body mass index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Clinical efficacy and imaging evaluation before and after surgery.\u003c/h2\u003e \u003cp\u003eAll patients successfully completed the surgery and followed up for more than 12 months. At the last follow-up, VAS, AOFAS, and Kofoed scores showed significant improvement compared to preoperative levels, with statistically significant differences (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Evaluate the ankle function at the last follow-up based on the AOFAS score, with 12 cases rated as excellent, 9 cases rated as good, and an excellent-good rate of 100% (21/21). Based on the Kofoed score, evaluate the ankle function at the last follow-up, with 16 cases rated as excellent, 5 cases rated as good, and an excellent-good rate of 100% (21/21). At the last follow-up, the MOCART score was 69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 (53\u0026ndash;89). No complications such as wound infection, necrosis, vascular nerve injury, and donor site pain occurred in all patients after surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and radiological outcome scores at preoperative and final follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinal Follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOFAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKofoed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe talus can be anatomically divided into three distinct regions: head, neck, and body, with most of its surface covered by articular cartilage. This cartilage tissue is avascular and lacks neural nourishment, and as a bone without muscle attachment, its nutrition mainly relies on synovial fluid. These factors collectively lead to the difficulty in achieving effective self-repair after injury [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. OLT is a common cause of ankle pain and dysfunction, and severe cartilage injuries (Hepple IV-V type) with subchondral cyst formation often require surgical intervention [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There are numerous surgical methods for OLT and their efficacy remains controversial. Bone marrow stimulation (BMS) is the gold standard for treating OLT [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], primarily indicated for lesions with an area of \u0026lt;\u0026thinsp;1.5 cm\u0026sup2; and a depth of \u0026lt;\u0026thinsp;5 mm [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the fibrocartilage regenerated by microfractures is mainly composed of Type I collagen, which has significant biological differences compared to the Type II collagen that constitutes the normal cartilage of the talus. The elasticity and wear resistance of fibrocartilage are inferior to that of normal cartilage, making it more denaturation to degeneration under shear stress [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Researchers have found that the cartilage repair scores observed during secondary arthroscopy examination after BMS were significantly lower than those of cartilage transplantation or retrograde drilling, with 36% of lesions remained incompletely healed [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. PRP is rich in growth factors, fibrinogen, and various bioactive substances, which can promote the repair of damaged cartilage tissue [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study demonstrates that full-arthroscopic cancellous bone grafting combined with PRP injection for the treatment of OLT can effectively repair cartilage injury, while simultaneously alleviating pain in the affected limb and improving ankle joint function, with satisfactory short-term efficacy.\u003c/p\u003e \u003cp\u003eIt is usually required to perform osteotomy of the medial or lateral malleolus to adequately expose the lesion area due to the intricate anatomical structure of the ankle joint, [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which disrupts the normal anatomical structure and damages the blood supply around the talus. At the same time, there are complications such as intraoperative cartilage iatrogenic injury, delayed healing or non-healing of the osteotomy site, chronic pain or swelling, and the need for secondary surgery to remove internal fixation devices [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The advantages of traditional open surgery in providing a surgical field for OLT can now be achieved through arthroscopic procedures. Arthroscopic cancellous bone grafting for OLT has been demonstrated to significantly reduce pain and restore ankle joint function [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In present study, we observed the lesion area and performed bone graft through arthroscopy, whose primary advantages include: (1) performs through a small incision, reducing surgical trauma and protecting the blood supply of local tissues, thereby palliate postoperative pain and inflammatory response, promoting early activity and functional recovery; (2) minimizes complications commonly associated with open osteotomy procedures, shortens hospital stays, and accelerates recovery; (3) eliminates the need for internal fixation devices and intraoperative fluoroscopy, reducing radiation exposure for both patients and medical staff, and avoids the necessity for secondary surgeries to remove internal fixators. Cancellous bone possesses numerous trabecular spaces and a soft texture, which can adapt to the shape of the damaged area and provide effective structural support, facilitating the growth of blood vessels and fibrous tissue, and helping to restore the bone integrity and function [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Regarding the harvest of cancellous bone, previous literature has reported that the iliac crest, distal tibia, and the ankle bone itself are common donor sites [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The iliac crest has demonstrated favorable outcomes in reducing donor site complications and is one of the frequently utilized transplantation sites. In this study, selection of the ipsilateral tibial Gerdy tubercle for obtaining cancellous bone has the following two major advantages: (1) There is no need to enlarge the surgical disinfection area. (2) The Gerdy tubercle is far from the joint surface, thereby minimizing the risk of damage to the articular cartilage surface [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In terms of our experience with cancellous bone transplantation: first, the cancellous bone is placed into the defect area and compacted through the bone graft sleeve, while PRP is applied to the surface of the cancellous bone and the effect of gravity can further prevent autologous cancellous bone displacement. A study by Rikken reported on arthroscopic BMS for OLT with at least 8 years of follow-up, and approximately 1/3 of the patients showed progressive cartilage degeneration on imaging, with even the risk of developing end-stage ankle arthritis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A randomized controlled trial (RCT) study on PRP demonstrated that PRP injection after microfracture achieved superior mid-term outcomes compared to hyaluronic acid [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The meta-analysis by Woo et al. included 235 patients with OLT, and the results showed that the effect of the ankle arthroscopy microfracture combined with PRP group was significantly better than that of the simple microfracture or combined with other biological agents [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, we achieved precise targeted injections under arthroscopic monitoring, with PRP and thrombin prepared into a gel that firmly adheres to the cartilage defect area, which is beneficial for better repair of OLT. The MOCART score was 69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 at 1-year follow-up, which is higher than the treatment effect of simple microfracture reported in previous studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], indicating that PRP injection can compensate for the inherent limitations of microfracture surgery and promote the cartilage repair and integration.\u003c/p\u003e \u003cp\u003eThis study also has some limitations. Firstly, it is a retrospective study with a small sample size and a short follow-up period, lacking comparison with other commonly surgical approaches. Secondly, medical ethics limited postoperative secondary arthroscopic evaluation of cartilage recovery. It is necessary to conduct multi-center, large-sample, long-term follow-up studies to evaluate and verify clinical effects and complications. In summary, full-arthroscopic cancellous bone grafting combined with PRP injection for the treatment of severe OLT can reduce pain in the affected limb, improve ankle joint function, and effectively repair cartilage injury, demonstrating satisfactory short-term efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study has been approved by the Ethics Committee of Xuzhou Renci Hospital (ID: XZRCLL-LW-202011001) and complies with the requirements of the Declaration of Helsinki. All patients have provided informed consent and signed the informed consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eThe study has obtained informed consent from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe data with article can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was supported by the \u0026ldquo;Scientific Research Surface Project of Jiangsu Provincial Healthcare Commission (Grant No. H2019023) and General Science and Technology Project of Xuzhou Municipal Health Commission (Grant No. XWKYHT20240039)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHao Han, Qi Lu: Conceptualization and study design, statistical analysis and manuscript drafting;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLong Yang, Yaozhou Shi: Patient data follow-up and collection\u003c/p\u003e\n\u003cp\u003eYuehua Hui: Postoperative care guidelines\u003c/p\u003e\n\u003cp\u003eRongjian Shi, Qinwei Guo: Surgical procedures instruction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJie Li and Guangchao Cao: Manuscript review, research guidance and funding support\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe appreciate the guidance and strong support from department leaders and colleagues throughout this research project and manuscript collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHao Han\u003csup\u003e\u0026nbsp;1, 3\u003c/sup\u003e, Qi Lu\u003csup\u003e1\u003c/sup\u003e , Long Yang\u003csup\u003e1\u003c/sup\u003e，Yaozhou Shi\u003csup\u003e1\u003c/sup\u003e, Yuehua Hui\u003csup\u003e1\u003c/sup\u003e, Rongjian Shi\u003csup\u003e1\u003c/sup\u003e, Qinwei Guo\u003csup\u003e2\u003c/sup\u003e，Jie Li\u003csup\u003e3\u003c/sup\u003e，Guangchao Cao\u003csup\u003e1*\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e1. Department of Foot and Ankle Surgery, Xuzhou Renci Hospital, Xuzhou 221000, Jiang Su, China\u003c/p\u003e\n\u003cp\u003e2. Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China\u003c/p\u003e\n\u003cp\u003e3. Department of Orthopaedic, Xuzhou Central Hospital Affiliated to Southeast University, Xu Zhou 221000, Jiang Su, China\u003c/p\u003e\n\u003cp\u003e*\u003cstrong\u003eCorresponding author:\u003c/strong\u003e Guangchao Cao\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence E-mail:\u0026nbsp;\u003c/strong\[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. 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J Am Acad Orthop Surg 28:e878-e887. http://dx.doi.org/10.5435/jaaos-d-20-00116\u003c/li\u003e\n\u003cli\u003eCheng L, Wang X (2024) Advancements in the treatment of osteochondral lesions of the talus. J Orthop Surg Res 19:827. http://dx.doi.org/10.1186/s13018-024-05314-6\u003c/li\u003e\n\u003cli\u003ePark JH, Park KH, Cho JY, Han SH, Lee JW (2021) Bone Marrow Stimulation for Osteochondral Lesions of the Talus: Are Clinical Outcomes Maintained 10 Years Later? Am J Sports Med 49:1220-1226. http://dx.doi.org/10.1177/0363546521992471\u003c/li\u003e\n\u003cli\u003eAurich M, Albrecht D, Angele P, Becher C, Fickert S, Fritz J, M\u0026uuml;ller PE, Niemeyer P, Pietschmann M, Spahn G, Walther M (2017) [Treatment of Osteochondral Lesions in the Ankle: A Guideline from the Group \u0026quot;Clinical Tissue Regeneration\u0026quot; of the German Society of Orthopaedics and Traumatology (DGOU)]. 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Foot Ankle Int 36:891-900. http://dx.doi.org/10.1177/1071100715578435\u003c/li\u003e\n\u003cli\u003eDrakos MC, Eble SK, Cabe TN, Patel K, Hansen OB, Sofka C, Fabricant PD, Deland JT (2021) Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture. Foot Ankle Int 42:841-850. http://dx.doi.org/10.1177/1071100720983266\u003c/li\u003e\n\u003cli\u003eLee YK, Young KW, Kim JS, Lee HS, Cho WJ, Kim HN (2020) Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial. BMC Musculoskelet Disord 21:716. http://dx.doi.org/10.1186/s12891-020-03730-3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8463516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8463516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe purpose of this study is to evaluate the clinical and radiological outcomes of arthroscopic autologous cancellous bone grafting combined with PRP injection in patients with osteochondral lesions of talus (OLT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThis study was conducted at Xuzhou Renci Hospital from January 2020 to June 2023, including patients diagnosed with Hepple stage IV or V OLT by magnetic resonance imaging (MRI). Surgical interventions included debridement and microfracture under arthroscopy, autologous cancellous bone grafting, and PRP injection. Preoperative and postoperative assessments were performed using the visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, Kofoed score, and magnetic resonance observation of cartilage repair tissue (MOCART). Paired sample t-test was used for statistical analysis to compare data before and after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTwenty-one patients were enrolled, demonstrating significant postoperative improvements in VAS scores, AOFAS ankle-hindfoot scores, Kofoed scores (P \u0026lt; 0.05). Radiological examination showed good cartilage regeneration effects. No complications occurred in all patients, and no adverse reactions were observed at the donor knee site.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eArthroscopic microfracture combined with autologous cancellous bone grafting and PRP injection is a promising technique for treating OLT, with good short-term outcomes and a high patient satisfaction rate, requiring further research for confirmation.\u003c/p\u003e","manuscriptTitle":"Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 00:35:58","doi":"10.21203/rs.3.rs-8463516/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T08:29:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T16:07:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T12:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27670542119616209398768041756662483289","date":"2026-03-09T16:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139423152223735743671773311949499126674","date":"2026-03-09T06:13:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12749974774539315472358453137347650464","date":"2026-03-04T03:14:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-23T08:15:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-20T23:32:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T23:31:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-12-28T01:44:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cd5f775-f303-4c50-8ea9-b4ed01de4f5a","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T12:06:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 00:35:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8463516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8463516","identity":"rs-8463516","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}