Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study

Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study | 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 Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study Wei Li, Weiqi Kong, Ying Zhu, Weiwei Mao, Ying Wang, Jianzhong Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7476451/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Osteochondral lesion of the talus Microfracture Autologous osteochondral transplantation Figures Figure 1 Figure 2 Introduction Osteochondral lesions of the talus (OLT) typically result from traumatic or non-traumatic factors, involving damage to the talar cartilage and subchondral bone, leading to cartilage detachment, fragmentation, and associated symptoms such as ankle weakness, pain, and cyst formation[ 1 ]. For small focal OLT (lesion area < 100 mm²), common surgical treatments include bone marrow stimulation (BMS) and retrograde drilling[ 2 ]. Due to its superior short-term efficacy, minimal invasiveness, cost-effectiveness, and technical feasibility, BMS has become the preferred treatment for small focal OLT [ 3 ]. However, long-term follow-up studies report a clinical success rate of only 57% for BMS[ 4 ], with arthroscopic findings revealing fibrous cartilage repair tissue that exhibits poor biomechanical properties [ 3 ]. Additionally, the failure rate increases significantly for lesions deeper than 5 mm [ 5 ]. In contrast, osteochondral autologous transplantation (AOT) demonstrates a higher clinical success rate of 91% compared to BMS [ 4 ]. However, AOT is typically reserved indicated for larger OLT lesions (> 100 mm²) and often utilized the knee as the donor site, which carried risks of donor-site morbidity, including persistent knee pain [ 6 ]. Applying AOT to small focal OLT may unnecessarily increase these mentioned complications. Autologous osteoperiosteal transplantation (AOPT), which uses iliac bone as the donor site, has shown poor cartilage and subchondral bone repair on postoperative CT scans [ 7 ]. To minimize donor-site complications while effectively treating small focal OLT with deeper lesions (> 5 mm), this study employs autologous non-weight-bearing talar osteochondral grafts. This donor site exhibits histocompatibility with the injured talus, ensuring optimal biological integration, accelerated cartilage regeneration, and anatomical surface restoration[ 8 ]. We hypothesize that autologous non-weight-bearing talar osteochondral transplantation provides superior clinical outcomes for small focal OLT with lesion depths > 5 mm compared to BMS. To validate this hypothesis, we performed a retrospective cohort analysis of 32 consecutive OLT cases, systematically comparing intraoperative techniques and postoperative outcomes between autologous talar osteochondral transplantation and microfracture procedures. The comparative efficacy analysis is presented below. Materials and Methods This retrospective study evaluated patients with osteochondral lesions of the talus (OLT) treated between June 2018 and June 2023. The study protocol was approved by the institutional review board, and all participants provided informed consent. Patients were included if they had: (1) persistent ankle pain with functional limitation, (2) CT-confirmed OLT lesions 5 mm in depth, (3) failed conservative management for ≥ 3 months, and (4) minimum 12-month follow-up. Exclusion criteria included: incomplete medical records, Hepple stage IV or higher lesions, concurrent severe ankle deformity or osteoarthritis, and systemic arthropathies such as gout or rheumatoid arthritis. The study cohort consisted of 32 patients (15 male, 17 female) with a mean age of 36.3 ± 11.8 years. Lesion distribution demonstrated right ankle predominance (n = 19, 59.4%) compared to left ankle involvement (n = 13, 40.6%). Based on preoperative imaging and clinical evaluation, 18 patients underwent arthroscopic microfracture while 14 received autologous talar osteochondral transplantation. All patients reported prior ankle trauma, with persistent pain being the primary complaint. Baseline characteristics revealed no significant differences in age or gender between groups (P > 0.05), though lesion depth showed significant variation (P < 0.01). Table 1 Comparative Characteristics of Microfracture and Osteochondral Transplantation Cohorts. Group BMS AOT P Value Number of patients 18 14 Lesion location (left/right) 10/8 6/8 Follow-up duration (months) 34 ± 12.08 36.14 ± 13.73 Gender (male/female) 12/6 10/4 Age (years) 33.89 ± 12.97 39.29 ± 9.84 0.21 BMI (kg/m²) 20.89 ± 2.28 21.58 ± 2.85 0.44 Lesion depth (mm) 6.49 ± 0.76 8.30 ± 0.86 < .01 Data are presented as mean ± SD or number. Statistically significant (P <0.01). Preoperative assessment included standardized CT protocols with triplane measurements (coronal, sagittal, axial) for precise lesion volumetry and surgical planning. 3D computed tomography reconstruction was selectively employed for morphologically complex lesions requiring precise preoperative planning. Surgical procedure All procedures were performed under general anesthesia with patients in the supine position and thigh tourniquet application. In the autologous talar osteochondral transplantation group, diagnostic arthroscopy was initially conducted to confirm lesion topography and dimensions. This was followed by a 6-cm medial malleolar incision and oblique osteotomy, allowing direct visualization of the talar dome. The osteochondral defect was completely resected en bloc using a standardized cylindrical coring system (Arthrex), ensuring perpendicular alignment to the articular surface and preservation of the surrounding healthy cartilage margins, then cylindrical grafts were harvested from the ipsilateral non-weight-bearing talar region. The excised pathological osteochondral core from the lesion site was then used to backfill the donor site defect. Precise press-fit implantation of the autograft was secured, with final fixation of the malleolar osteotomy achieved using two cannulated screws (4.0 mm diameter), verified by intraoperative fluoroscopy.The microfracture group received standard dual-portal arthroscopy with complete debridement of unstable cartilage and subchondral perforation, preserving the calcified cartilage layer. Postoperative rehabilitation Postoperative management involved short-leg cast immobilization for 3 weeks, followed by progressive range-of-motion exercises (weeks 3–6) and protected weight-bearing transition (weeks 6–8). Outcome measures Outcome measures Sport-specific rehabilitation commenced 3 months postoperatively. Follow-up evaluations occurred at 6 weeks, 3 months, 6 months, 12 months, and annually thereafter, assessing clinical and radiographic outcomes using Visual Analog Scale (VAS) for pain, AOFAS Ankle-Hindfoot Scale, and MOCART MRI scoring system[ 9 ]. Statistical analysis SPSS software (Version 24.0; SPSS, Inc) was used for all statistical analyses. Normality was assessed using the Shapiro-Wilk test. Intergroup comparisons employed independent t-tests for normally distributed data and Mann-Whitney U tests for non-normal distributions, with statistical significance set at P < 0.01. Results Clinical outcomes Preoperative evaluation showed statistically significant differences in VAS pain scores and AOFAS-AH functional scores between groups (P < 0.01), with better baseline function in the microfracture group. Postoperatively, VAS scores improved comparably (P = 0.58), but AOFAS scores remained significantly higher in the transplantation group (P < 0.01). MRI at 6 months revealed superior cartilage repair in the transplantation group (MOCART 85.79 ± 2.49 vs 79.50 ± 3.09, P < 0.01). Table 2 Functional outcomes comparison of the two groups. Functional Outcomes BMS (n = 18) AOT (n = 14) P Value Visual analog scale Preoperative 3.44 ± 0.62 5.57 ± 0.76 < .01 Final follow-up 1.39 ± 0.50 1.29 ± 0.47 .58 P value < .01 < .01 AOFAS-AH Preoperative 60.39 ± 5.65 50.93 ± 6.12 < .01 Final follow-up 79.61 ± 6.59 88.64 ± 3.88 < .01 P value < .01 < .01 Mocart Final follow-up 79.50 ± 3.09 88.64 ± 3.88 < .01 Data are presented as mean ± SD or number. Statistically significant (P <0.01).Abbreviations: AOFAS-AH, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale Recurrence and complications No recurrences occurred in the transplantation group throughout the study period, while one microfracture case (5.6%) required revision surgery. All osteotomies healed without delay, and no donor-site complications or osteoarthritis developed in either group. Figure 2 illustrates typical postoperative outcomes, demonstrating successful lesion repair in both treatment groups with maintained joint congruity and no radiographic signs of degenerative changes. Discussion Our findings demonstrate the feasibility and efficacy of AOT for treating small focal OLT, with demonstrated significantly better clinical outcomes compared to BMS in lesions deeper than 5mm and reduced recurrence rates. The talus is covered by hyaline cartilage over two-thirds of its surface, making it particularly vulnerable to traumatic injury with limited healing capacity. BMS represents the most frequently employed surgical intervention for small focal OLT in current clinical practice, leveraging mesenchymal stem cell recruitment to induce fibrocartilaginous repair at defect sites[ 4 ]. While our BMS group showed significant pain relief (VAS: 3.44 ± 0.62 to 1.39 ± 0.50) and functional improvement (AOFAS-AH: 60.39 ± 5.65 to 79.50 ± 3.09), the fibrocartilage's inferior biomechanical properties compared to native hyaline cartilage ultimately limit long-term outcomes[ 10 ]. This underscores the necessity for complete anatomical restoration of talar cartilage defects. AOT utilizing autologous grafts from the ipsilateral non-weight-bearing talar region offers several advantages: the transplanted hyaline cartilage maintains superior biological properties and integrates rapidly with surrounding native tissue. Our AOT group achieved excellent clinical results (VAS: 5.57 ± 0.76 to 1.29 ± 0.47; AOFAS-AH: 50.93 ± 6.12 to 88.64 ± 3.88), consistent with previous reports of AOT's superiority over BMS[ 4 ]. Notably, while postoperative pain relief was comparable between groups (P = 0.58), functional recovery (P = 0.001) and cartilage repair quality (MOCART: 85.79 ± 2.49 vs 79.50 ± 3.09, P < 0.01) significantly favored AOT, confirming better osteochondral restoration. The study reveals important considerations for surgical selection. While BMS demonstrates satisfactory short-term outcomes for shallow lesions, its efficacy declines with increasing defect depth due to inadequate subchondral bone support[ 11 ]. Our results corroborated the previously established association by Chayanin et al. between lesion depth and clinical outcomes in BMS-treated OLT cases[ 12 ]. The AOT group, despite presenting with more severe baseline pathology (deeper lesions, worse preoperative scores), achieved superior functional restoration by reconstructing both cartilage and weight-bearing subchondral bone, potentially reducing long-term osteoarthritis risk and reoperation rates[ 13 ]. We addressed two major AOT complications through technical modifications: First, by precisely matching graft dimensions using preoperative CT measurements and harvesting from homologous talar sites, we minimized interface gaps that predispose to subchondral cyst formation (reported in 64.9% of cases in prior studies)[ 14 ]. Second, avoiding knee donor sites eliminated the risk of persistent knee pain, a common complication in traditional AOT approaches[ 15 ]. Postoperative imaging confirmed excellent graft integration and articular surface congruity in our series, contrasting with previous reports of surface irregularities when using heterotopic (knee-derived) grafts[ 16 ]. Based on our experience, we emphasize three surgical principles: (1) meticulous preoperative planning using advanced imaging to determine optimal graft size, (2) surgical grafts were systematically harvested from anatomically defined non-load-bearing regions, and (3) minimal graft manipulation to preserve tissue integrity. These measures collectively contribute to reducing postoperative complications. Study limitations include potential selection bias inherent to retrospective designs, the absence of intermediate outcome timepoints, and relatively short follow-up duration. These preliminary findings necessitate future multicenter randomized controlled trials featuring adequately powered sample sizes, standardized outcome measures, and minimum 5-year follow-up periods to establish therapeutic durability and optimize clinical guidelines. Nevertheless, our results provide compelling evidence that talar-derived AOT offers a superior therapeutic option for deep small focal OLT, combining anatomical restoration with favorable safety profile. Conclusion This study demonstrates that AOT is a safe and effective treatment for small focal OLT, particularly those deeper than 5 mm, offering superior functional recovery and cartilage repair quality compared to BMS. While both techniques provided significant pain relief, AOT resulted in better long-term functional outcomes (AOFAS-AH scores, P = 0.001) and higher-quality cartilage regeneration (MOCART scores, P < 0.01). Additionally, AOT reduced recurrence rates (0% vs. 5.6% in BMS) and avoided donor-site complications by utilizing ipsilateral non-weight-bearing talar grafts rather than knee-derived cartilage. Declarations Ethics approval and consent to participate All patients provided written informed consent. Consent for publication Informed consent was obtained from all the patients in this study for the article to be published. Availability of data and materials The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study is supported by the Open Research Fund of the State Key Laboratory of Biotherapy, grant NO. (SKLB202409); the Project of Suzhou Sports Bureau, grant NO. (TY2024-103); the Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University, grant NO. (GZK1202303); the Project of Second Affiliated Hospital of Soochow University 'Resident Standardized Training Capacity Building Support Program', grant NO. (ZPTJ-TD202405); the Project of 2023 'Four-Party Co-Construction' Special Project on Education and Teaching Reform of Suzhou Medical College, grant NO. (MX12301923). Author contributions LW, KWQ and ZY contributed equally to this work and should be considered co-first authors. MWW collected and analysed the data. WY conceived and coordinated the study, designed. QJZ conceived and supervised the work, and wrote the paper. All authors reviewed the manuscript. Acknowledgements Not applicable Authors' information 1 Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China. 2 Department of Wound Center, the Second Affiliated Hospital of Soochow University, Suzhou, China. References Bai, L., et al., Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation. Orthop J Sports Med, 2020. 8 (7): p. 2325967120937798. Barbier, O., Osteochondral lesions of the talar dome. Orthop Traumatol Surg Res, 2023. 109 (1s): p. 103452. 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Aldahshan, W.A., et al., Lesion depth and marrow stimulation results. Foot Ankle Surg, 2023. 29 (2): p. 165-170. Bruns, J., C. Habermann, and M. Werner, Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans. Cartilage, 2021. 13 (1_suppl): p. 1380s-1401s. Georgiannos, D., I. Bisbinas, and A. Badekas, Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2016. 24 (12): p. 3722-3729. Hollander, J.J., et al., The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions. Cartilage, 2023. 14 (2): p. 180-197. Guo, H., et al., Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Orthop Surg, 2023. 15 (1): p. 103-110. Sammarco, G.J. and N.K. Makwana, Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int, 2002. 23 (8): p. 693-8. Kreuz, P.C., et al., Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med, 2006. 34 (1): p. 55-63. Shafshak, T.S. and R. Elnemr, The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain. J Clin Rheumatol, 2021. 27 (7): p. 282-285. Erichsen, J., et al., Danish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures. J Foot Ankle Surg, 2020. 59 (4): p. 657-663. Zhang, Y., et al., Triplane osteotomy combined with talar non-weight-bearing area autologous osteochondral transplantation for osteochondral lesions of the talus. BMC Musculoskelet Disord, 2022. 23 (1): p. 79. Steele, J.R., et al., Republication of "Osteochondral Lesions of the Talus: Current Concepts in Diagnosis and Treatment". Foot Ankle Orthop, 2023. 8 (3): p. 24730114231192961. Choi, W.J., et al., Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med, 2009. 37 (10): p. 1974-80. Angthong, C., et al., Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus. Knee Surg Sports Traumatol Arthrosc, 2013. 21 (6): p. 1418-26. Wan, D.D., et al., Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets. Int Orthop, 2022. 46 (7): p. 1547-1555. Savage-Elliott, I., et al., Magnetic Resonance Imaging Evidence of Postoperative Cyst Formation Does Not Appear to Affect Clinical Outcomes After Autologous Osteochondral Transplantation of the Talus. Arthroscopy, 2016. 32 (9): p. 1846-54. Carrino, J.A., et al., MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthritis Cartilage, 2006. 14 (10): p. 1081-5. Flynn, S., et al., Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus. Foot Ankle Int, 2016. 37 (4): p. 363-72. Woelfle, J.V., et al., Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus. Foot Ankle Int, 2013. 34 (2): p. 173-9. Imhoff, A.B., et al., Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation. Am J Sports Med, 2011. 39 (7): p. 1487-93. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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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-7476451","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513044942,"identity":"b94c0c91-ab46-4be2-aa1f-d1bb328ad4f8","order_by":0,"name":"Wei Li","email":"","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Li","suffix":""},{"id":513044944,"identity":"b60bd913-4a5f-4bb2-becf-c7a3ccffeddf","order_by":1,"name":"Weiqi Kong","email":"","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Weiqi","middleName":"","lastName":"Kong","suffix":""},{"id":513044948,"identity":"acbfbf29-2731-4867-b9a0-0aa301fae6d5","order_by":2,"name":"Ying Zhu","email":"","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Zhu","suffix":""},{"id":513044950,"identity":"e6526442-9b4a-45cf-a316-9d57dc4fb500","order_by":3,"name":"Weiwei Mao","email":"","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Mao","suffix":""},{"id":513044952,"identity":"cca2ada3-8938-4312-b92c-a4cc79c8a07e","order_by":4,"name":"Ying Wang","email":"","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Wang","suffix":""},{"id":513044954,"identity":"b24b5e06-7fec-4344-b7c2-d60836e9ce30","order_by":5,"name":"Jianzhong Qin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIie2Ru0oDQRSGJwyMzWTTzjaLj3BkYFQI5EFszjZbKVhJii0CwtpEfZWALzBwIGmGpLWwGBuxjI2kUmcTxWp3UwrOV8wF/u/M5TAWifxFOGOAYYZ6g+PPbMA5+f0V77hOb0QBe51Wp3rPFc9nK3mo2pLJom8vffk0Oj64pde8ElqTDH45PGtSUkoQcP7CT6fL4gSXMjPUt57Ni4tJ031IAqAgAY/nBvBKaVMX6U2oQ/kI41YRkD9cS1CdSl6RCor2WGE+4x1KulXuCMA5w9BZrSh8Mra8JVk5c7R5pxEspvptM7bZ4J7Ir8tho8IsEz+NE7/twKb4TuH+e8nXbcFIJBL5v3wBiwBfBd3/s18AAAAASUVORK5CYII=","orcid":"","institution":"Second Affiliated Hospital of Soochow University","correspondingAuthor":true,"prefix":"","firstName":"Jianzhong","middleName":"","lastName":"Qin","suffix":""}],"badges":[],"createdAt":"2025-08-28 05:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7476451/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7476451/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91196916,"identity":"9d570002-f2ec-4141-81da-96796307cad0","added_by":"auto","created_at":"2025-09-12 15:07:34","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":746630,"visible":true,"origin":"","legend":"\u003cp\u003eAutologous Osteochondral Transplantation Procedure: (a) A 6.0-cm longitudinal incision was made over the medial malleolus. An oblique osteotomy was performed from 4.0 cm proximal to the malleolar tip toward the talar dome vertex, with medial reflection of the osteotomized fragment to expose the medial talar dome; (b) The osteochondral lesion was excised en bloc using a cylindrical harvesting device; (c) A cylindrical osteochondral graft was harvested from the non-weight-bearing zone of the medial talus using a coring system; (d) The harvested osteochondral plug from the talar non-weight-bearing region; (e) The cylindrical autograft was precisely implanted into the prepared talar defect site; (f) The donor site was grafted with the excised pathological osteochondral core.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7476451/v1/bb5bb3265ad022a99bdcf1b1.jpeg"},{"id":91198526,"identity":"01f7fdbc-07c9-454f-ad35-beed20e5f7ff","added_by":"auto","created_at":"2025-09-12 15:15:34","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1625478,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative MRI findings in an OLT patient treated with AOT: (a) Axial, sagittal, and coronal planes demonstrating the osteochondral lesion preoperatively; (b) Corresponding postoperative views showing graft integration and articular surface restoration\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7476451/v1/5b52b1a0196058358058dd76.jpeg"},{"id":92044950,"identity":"ba4bdaee-142d-4557-ab5e-1fa8ecb433ab","added_by":"auto","created_at":"2025-09-24 04:09:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2184081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7476451/v1/f1ac966f-42dc-4a49-938f-cc70fb796277.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cb\u003eOsteochondral lesions of the talus (OLT)\u003c/b\u003e typically result from traumatic or non-traumatic factors, involving damage to the talar cartilage and subchondral bone, leading to cartilage detachment, fragmentation, and associated symptoms such as ankle weakness, pain, and cyst formation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor small focal OLT (lesion area\u0026thinsp;\u0026lt;\u0026thinsp;100 mm\u0026sup2;), common surgical treatments include bone marrow stimulation (BMS) and retrograde drilling[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to its superior short-term efficacy, minimal invasiveness, cost-effectiveness, and technical feasibility, BMS has become the preferred treatment for small focal OLT [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, long-term follow-up studies report a clinical success rate of only 57% for BMS[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], with arthroscopic findings revealing fibrous cartilage repair tissue that exhibits poor biomechanical properties [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Additionally, the failure rate increases significantly for lesions deeper than 5 mm [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn contrast, osteochondral autologous transplantation (AOT) demonstrates a higher clinical success rate of 91% compared to BMS [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, AOT is typically reserved indicated for larger OLT lesions (\u0026gt;\u0026thinsp;100 mm\u0026sup2;) and often utilized the knee as the donor site, which carried risks of donor-site morbidity, including persistent knee pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Applying AOT to small focal OLT may unnecessarily increase these mentioned complications.\u003c/p\u003e\u003cp\u003eAutologous osteoperiosteal transplantation (AOPT), which uses iliac bone as the donor site, has shown poor cartilage and subchondral bone repair on postoperative CT scans [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To minimize donor-site complications while effectively treating small focal OLT with deeper lesions (\u0026gt;\u0026thinsp;5 mm), this study employs autologous non-weight-bearing talar osteochondral grafts. This donor site exhibits histocompatibility with the injured talus, ensuring optimal biological integration, accelerated cartilage regeneration, and anatomical surface restoration[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe hypothesize that autologous non-weight-bearing talar osteochondral transplantation provides superior clinical outcomes for small focal OLT with lesion depths\u0026thinsp;\u0026gt;\u0026thinsp;5 mm compared to BMS. To validate this hypothesis, we performed a retrospective cohort analysis of 32 consecutive OLT cases, systematically comparing intraoperative techniques and postoperative outcomes between autologous talar osteochondral transplantation and microfracture procedures. The comparative efficacy analysis is presented below.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis retrospective study evaluated patients with osteochondral lesions of the talus (OLT) treated between June 2018 and June 2023. The study protocol was approved by the institutional review board, and all participants provided informed consent.\u003c/p\u003e\u003cp\u003ePatients were included if they had: (1) persistent ankle pain with functional limitation, (2) CT-confirmed OLT lesions\u0026thinsp;\u0026lt;\u0026thinsp;100 mm\u0026sup2; in area and \u0026gt;\u0026thinsp;5 mm in depth, (3) failed conservative management for \u0026ge;\u0026thinsp;3 months, and (4) minimum 12-month follow-up. Exclusion criteria included: incomplete medical records, Hepple stage IV or higher lesions, concurrent severe ankle deformity or osteoarthritis, and systemic arthropathies such as gout or rheumatoid arthritis.\u003c/p\u003e\u003cp\u003eThe study cohort consisted of 32 patients (15 male, 17 female) with a mean age of 36.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 years. Lesion distribution demonstrated right ankle predominance (n\u0026thinsp;=\u0026thinsp;19, 59.4%) compared to left ankle involvement (n\u0026thinsp;=\u0026thinsp;13, 40.6%). Based on preoperative imaging and clinical evaluation, 18 patients underwent arthroscopic microfracture while 14 received autologous talar osteochondral transplantation. All patients reported prior ankle trauma, with persistent pain being the primary complaint. Baseline characteristics revealed no significant differences in age or gender between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), though lesion depth showed significant variation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\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\u003eComparative Characteristics of Microfracture and Osteochondral Transplantation Cohorts.\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eAOT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion location (left/right)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up duration (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.14\u0026thinsp;\u0026plusmn;\u0026thinsp;13.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (male/female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e10/4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.89\u0026thinsp;\u0026plusmn;\u0026thinsp;12.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e39.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e21.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion depth (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e8.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number. Statistically significant (P \u0026lt;0.01).\u003c/p\u003e\u003cp\u003ePreoperative assessment included standardized CT protocols with triplane measurements (coronal, sagittal, axial) for precise lesion volumetry and surgical planning. 3D computed tomography reconstruction was selectively employed for morphologically complex lesions requiring precise preoperative planning.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSurgical procedure\u003c/h2\u003e\u003cp\u003eAll procedures were performed under general anesthesia with patients in the supine position and thigh tourniquet application. In the autologous talar osteochondral transplantation group, diagnostic arthroscopy was initially conducted to confirm lesion topography and dimensions. This was followed by a 6-cm medial malleolar incision and oblique osteotomy, allowing direct visualization of the talar dome. The osteochondral defect was completely resected en bloc using a standardized cylindrical coring system (Arthrex), ensuring perpendicular alignment to the articular surface and preservation of the surrounding healthy cartilage margins, then cylindrical grafts were harvested from the ipsilateral non-weight-bearing talar region. The excised pathological osteochondral core from the lesion site was then used to backfill the donor site defect. Precise press-fit implantation of the autograft was secured, with final fixation of the malleolar osteotomy achieved using two cannulated screws (4.0 mm diameter), verified by intraoperative fluoroscopy.The microfracture group received standard dual-portal arthroscopy with complete debridement of unstable cartilage and subchondral perforation, preserving the calcified cartilage layer.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePostoperative rehabilitation\u003c/h3\u003e\n\u003cp\u003ePostoperative management involved short-leg cast immobilization for 3 weeks, followed by progressive range-of-motion exercises (weeks 3\u0026ndash;6) and protected weight-bearing transition (weeks 6\u0026ndash;8).\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eOutcome measures\u003c/div\u003e\u003cp\u003eSport-specific rehabilitation commenced 3 months postoperatively. Follow-up evaluations occurred at 6 weeks, 3 months, 6 months, 12 months, and annually thereafter, assessing clinical and radiographic outcomes using Visual Analog Scale (VAS) for pain, AOFAS Ankle-Hindfoot Scale, and MOCART MRI scoring system[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eSPSS software (Version 24.0; SPSS, Inc) was used for all statistical analyses. Normality was assessed using the Shapiro-Wilk test. Intergroup comparisons employed independent t-tests for normally distributed data and Mann-Whitney U tests for non-normal distributions, with statistical significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical outcomes\u003c/h2\u003e\u003cp\u003ePreoperative evaluation showed statistically significant differences in VAS pain scores and AOFAS-AH functional scores between groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with better baseline function in the microfracture group. Postoperatively, VAS scores improved comparably (P\u0026thinsp;=\u0026thinsp;0.58), but AOFAS scores remained significantly higher in the transplantation group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). MRI at 6 months revealed superior cartilage repair in the transplantation group (MOCART 85.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 vs 79.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\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\u003eFunctional outcomes comparison of the two groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunctional Outcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBMS\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAOT\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual analog scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAOFAS-AH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.39\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMocart\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number. Statistically significant (P \u0026lt;0.01).Abbreviations: AOFAS-AH, American Orthopaedic Foot \u0026amp; Ankle Society Ankle-Hindfoot Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRecurrence and complications\u003c/h3\u003e\n\u003cp\u003eNo recurrences occurred in the transplantation group throughout the study period, while one microfracture case (5.6%) required revision surgery. All osteotomies healed without delay, and no donor-site complications or osteoarthritis developed in either group. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates typical postoperative outcomes, demonstrating successful lesion repair in both treatment groups with maintained joint congruity and no radiographic signs of degenerative changes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings demonstrate the feasibility and efficacy of AOT for treating small focal OLT, with demonstrated significantly better clinical outcomes compared to BMS in lesions deeper than 5mm and reduced recurrence rates.\u003c/p\u003e\u003cp\u003eThe talus is covered by hyaline cartilage over two-thirds of its surface, making it particularly vulnerable to traumatic injury with limited healing capacity. BMS represents the most frequently employed surgical intervention for small focal OLT in current clinical practice, leveraging mesenchymal stem cell recruitment to induce fibrocartilaginous repair at defect sites[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While our BMS group showed significant pain relief (VAS: 3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 to 1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50) and functional improvement (AOFAS-AH: 60.39\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65 to 79.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09), the fibrocartilage's inferior biomechanical properties compared to native hyaline cartilage ultimately limit long-term outcomes[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This underscores the necessity for complete anatomical restoration of talar cartilage defects.\u003c/p\u003e\u003cp\u003eAOT utilizing autologous grafts from the ipsilateral non-weight-bearing talar region offers several advantages: the transplanted hyaline cartilage maintains superior biological properties and integrates rapidly with surrounding native tissue. Our AOT group achieved excellent clinical results (VAS: 5.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76 to 1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47; AOFAS-AH: 50.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12 to 88.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88), consistent with previous reports of AOT's superiority over BMS[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Notably, while postoperative pain relief was comparable between groups (P\u0026thinsp;=\u0026thinsp;0.58), functional recovery (P\u0026thinsp;=\u0026thinsp;0.001) and cartilage repair quality (MOCART: 85.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 vs 79.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) significantly favored AOT, confirming better osteochondral restoration.\u003c/p\u003e\u003cp\u003eThe study reveals important considerations for surgical selection. While BMS demonstrates satisfactory short-term outcomes for shallow lesions, its efficacy declines with increasing defect depth due to inadequate subchondral bone support[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our results corroborated the previously established association by Chayanin et al. between lesion depth and clinical outcomes in BMS-treated OLT cases[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The AOT group, despite presenting with more severe baseline pathology (deeper lesions, worse preoperative scores), achieved superior functional restoration by reconstructing both cartilage and weight-bearing subchondral bone, potentially reducing long-term osteoarthritis risk and reoperation rates[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe addressed two major AOT complications through technical modifications: First, by precisely matching graft dimensions using preoperative CT measurements and harvesting from homologous talar sites, we minimized interface gaps that predispose to subchondral cyst formation (reported in 64.9% of cases in prior studies)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Second, avoiding knee donor sites eliminated the risk of persistent knee pain, a common complication in traditional AOT approaches[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Postoperative imaging confirmed excellent graft integration and articular surface congruity in our series, contrasting with previous reports of surface irregularities when using heterotopic (knee-derived) grafts[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on our experience, we emphasize three surgical principles: (1) meticulous preoperative planning using advanced imaging to determine optimal graft size, (2) surgical grafts were systematically harvested from anatomically defined non-load-bearing regions, and (3) minimal graft manipulation to preserve tissue integrity. These measures collectively contribute to reducing postoperative complications.\u003c/p\u003e\u003cp\u003eStudy limitations include potential selection bias inherent to retrospective designs, the absence of intermediate outcome timepoints, and relatively short follow-up duration. These preliminary findings necessitate future multicenter randomized controlled trials featuring adequately powered sample sizes, standardized outcome measures, and minimum 5-year follow-up periods to establish therapeutic durability and optimize clinical guidelines. Nevertheless, our results provide compelling evidence that talar-derived AOT offers a superior therapeutic option for deep small focal OLT, combining anatomical restoration with favorable safety profile.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that AOT is a safe and effective treatment for small focal OLT, particularly those deeper than 5 mm, offering superior functional recovery and cartilage repair quality compared to BMS. While both techniques provided significant pain relief, AOT resulted in better long-term functional outcomes (AOFAS-AH scores, P\u0026thinsp;=\u0026thinsp;0.001) and higher-quality cartilage regeneration (MOCART scores, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, AOT reduced recurrence rates (0% vs. 5.6% in BMS) and avoided donor-site complications by utilizing ipsilateral non-weight-bearing talar grafts rather than knee-derived cartilage.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the patients in this study for the article to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is supported by the Open Research Fund of the State Key Laboratory of Biotherapy, grant NO. (SKLB202409); the Project of Suzhou Sports Bureau, grant NO. (TY2024-103); the Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University, grant NO. (GZK1202303);\u0026nbsp;the Project of Second Affiliated Hospital of Soochow University \u0026apos;Resident Standardized Training Capacity Building Support Program\u0026apos;, grant NO. (ZPTJ-TD202405); the Project of 2023 \u0026apos;Four-Party Co-Construction\u0026apos; Special Project on Education and Teaching Reform of Suzhou Medical College, grant NO. (MX12301923).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLW, KWQ and ZY contributed equally to this work and should be considered co-first authors. MWW collected and analysed the data. WY conceived and coordinated the study, designed. QJZ conceived and supervised the work, and wrote the paper. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Department of Wound Center, the Second Affiliated Hospital of Soochow University, Suzhou, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBai, L., et al., \u003cem\u003eClinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation.\u003c/em\u003e Orthop J Sports Med, 2020. \u003cstrong\u003e8\u003c/strong\u003e(7): p. 2325967120937798.\u003c/li\u003e\n\u003cli\u003eBarbier, O., \u003cem\u003eOsteochondral lesions of the talar dome.\u003c/em\u003e Orthop Traumatol Surg Res, 2023. \u003cstrong\u003e109\u003c/strong\u003e(1s): p. 103452.\u003c/li\u003e\n\u003cli\u003eKlammer, G., et al., \u003cem\u003eNatural history of nonoperatively treated osteochondral lesions of the talus.\u003c/em\u003e Foot Ankle Int, 2015. \u003cstrong\u003e36\u003c/strong\u003e(1): p. 24-31.\u003c/li\u003e\n\u003cli\u003eGobbi, A., et al., \u003cem\u003eOsteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.\u003c/em\u003e Arthroscopy, 2006. \u003cstrong\u003e22\u003c/strong\u003e(10): p. 1085-92.\u003c/li\u003e\n\u003cli\u003eToale, J., et al., \u003cem\u003eMidterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review.\u003c/em\u003e Orthop J Sports Med, 2019. \u003cstrong\u003e7\u003c/strong\u003e(10): p. 2325967119879127.\u003c/li\u003e\n\u003cli\u003eRikken, Q.G.H., et al., \u003cem\u003eTen-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus.\u003c/em\u003e J Bone Joint Surg Am, 2024.\u003c/li\u003e\n\u003cli\u003eVreeken, J.T., et al., \u003cem\u003eSecond-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.\u003c/em\u003e Cartilage, 2024: p. 19476035241227332.\u003c/li\u003e\n\u003cli\u003eAldahshan, W.A., et al., \u003cem\u003eLesion depth and marrow stimulation results.\u003c/em\u003e Foot Ankle Surg, 2023. \u003cstrong\u003e29\u003c/strong\u003e(2): p. 165-170.\u003c/li\u003e\n\u003cli\u003eBruns, J., C. Habermann, and M. Werner, \u003cem\u003eOsteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans.\u003c/em\u003e Cartilage, 2021. \u003cstrong\u003e13\u003c/strong\u003e(1_suppl): p. 1380s-1401s.\u003c/li\u003e\n\u003cli\u003eGeorgiannos, D., I. Bisbinas, and A. Badekas, \u003cem\u003eOsteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up.\u003c/em\u003e Knee Surg Sports Traumatol Arthrosc, 2016. \u003cstrong\u003e24\u003c/strong\u003e(12): p. 3722-3729.\u003c/li\u003e\n\u003cli\u003eHollander, J.J., et al., \u003cem\u003eThe Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions.\u003c/em\u003e Cartilage, 2023. \u003cstrong\u003e14\u003c/strong\u003e(2): p. 180-197.\u003c/li\u003e\n\u003cli\u003eGuo, H., et al., \u003cem\u003eAutologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions.\u003c/em\u003e Orthop Surg, 2023. \u003cstrong\u003e15\u003c/strong\u003e(1): p. 103-110.\u003c/li\u003e\n\u003cli\u003eSammarco, G.J. and N.K. Makwana, \u003cem\u003eTreatment of talar osteochondral lesions using local osteochondral graft.\u003c/em\u003e Foot Ankle Int, 2002. \u003cstrong\u003e23\u003c/strong\u003e(8): p. 693-8.\u003c/li\u003e\n\u003cli\u003eKreuz, P.C., et al., \u003cem\u003eMosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up.\u003c/em\u003e Am J Sports Med, 2006. \u003cstrong\u003e34\u003c/strong\u003e(1): p. 55-63.\u003c/li\u003e\n\u003cli\u003eShafshak, T.S. and R. Elnemr, \u003cem\u003eThe Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain.\u003c/em\u003e J Clin Rheumatol, 2021. \u003cstrong\u003e27\u003c/strong\u003e(7): p. 282-285.\u003c/li\u003e\n\u003cli\u003eErichsen, J., et al., \u003cem\u003eDanish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures.\u003c/em\u003e J Foot Ankle Surg, 2020. \u003cstrong\u003e59\u003c/strong\u003e(4): p. 657-663.\u003c/li\u003e\n\u003cli\u003eZhang, Y., et al., \u003cem\u003eTriplane osteotomy combined with talar non-weight-bearing area autologous osteochondral transplantation for osteochondral lesions of the talus.\u003c/em\u003e BMC Musculoskelet Disord, 2022. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 79.\u003c/li\u003e\n\u003cli\u003eSteele, J.R., et al., \u003cem\u003eRepublication of \u0026quot;Osteochondral Lesions of the Talus: Current Concepts in Diagnosis and Treatment\u0026quot;.\u003c/em\u003e Foot Ankle Orthop, 2023. \u003cstrong\u003e8\u003c/strong\u003e(3): p. 24730114231192961.\u003c/li\u003e\n\u003cli\u003eChoi, W.J., et al., \u003cem\u003eOsteochondral lesion of the talus: is there a critical defect size for poor outcome?\u003c/em\u003e Am J Sports Med, 2009. \u003cstrong\u003e37\u003c/strong\u003e(10): p. 1974-80.\u003c/li\u003e\n\u003cli\u003eAngthong, C., et al., \u003cem\u003eCritical three-dimensional factors affecting outcome in osteochondral lesion of the talus.\u003c/em\u003e Knee Surg Sports Traumatol Arthrosc, 2013. \u003cstrong\u003e21\u003c/strong\u003e(6): p. 1418-26.\u003c/li\u003e\n\u003cli\u003eWan, D.D., et al., \u003cem\u003eResults of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets.\u003c/em\u003e Int Orthop, 2022. \u003cstrong\u003e46\u003c/strong\u003e(7): p. 1547-1555.\u003c/li\u003e\n\u003cli\u003eSavage-Elliott, I., et al., \u003cem\u003eMagnetic Resonance Imaging Evidence of Postoperative Cyst Formation Does Not Appear to Affect Clinical Outcomes After Autologous Osteochondral Transplantation of the Talus.\u003c/em\u003e Arthroscopy, 2016. \u003cstrong\u003e32\u003c/strong\u003e(9): p. 1846-54.\u003c/li\u003e\n\u003cli\u003eCarrino, J.A., et al., \u003cem\u003eMRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts.\u003c/em\u003e Osteoarthritis Cartilage, 2006. \u003cstrong\u003e14\u003c/strong\u003e(10): p. 1081-5.\u003c/li\u003e\n\u003cli\u003eFlynn, S., et al., \u003cem\u003eAutologous Osteochondral Transplantation for Osteochondral Lesions of the Talus.\u003c/em\u003e Foot Ankle Int, 2016. \u003cstrong\u003e37\u003c/strong\u003e(4): p. 363-72.\u003c/li\u003e\n\u003cli\u003eWoelfle, J.V., et al., \u003cem\u003eClinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus.\u003c/em\u003e Foot Ankle Int, 2013. \u003cstrong\u003e34\u003c/strong\u003e(2): p. 173-9.\u003c/li\u003e\n\u003cli\u003eImhoff, A.B., et al., \u003cem\u003eOsteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation.\u003c/em\u003e Am J Sports Med, 2011. \u003cstrong\u003e39\u003c/strong\u003e(7): p. 1487-93.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Osteochondral lesion of the talus, Microfracture, Autologous osteochondral transplantation","lastPublishedDoi":"10.21203/rs.3.rs-7476451/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7476451/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: 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).\u003cbr\u003e\n\u003cstrong\u003eMethods\u003c/strong\u003e: 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 \u0026amp; 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.\u003cbr\u003e\n\u003cstrong\u003eResults\u003c/strong\u003e: 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 \u0026lt; 0.01).\u003cbr\u003e\n\u003cstrong\u003eConclusion\u003c/strong\u003e: Both AOT and BMS yield favorable outcomes for small focal OLT, but AOT demonstrates superior therapeutic efficacy compared to BMS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence:\u003c/strong\u003e Level III.\u003c/p\u003e","manuscriptTitle":"Autologous Talar Osteochondral Transplantation versus Microfracture for Small Focal Osteochondral Lesions of the Talus: A Preliminary Comparative Clinical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 14:59:29","doi":"10.21203/rs.3.rs-7476451/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"303dd39d-e593-483a-9bbc-820d6d6fb03f","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T04:08:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-12 14:59:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7476451","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7476451","identity":"rs-7476451","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}