Long-term positive outcomes and high survival after talus autologous osteochondral transplantation

Overview

This study demonstrates that autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) yields favorable long-term clinical, functional, and imaging outcomes with high graft survival rates. Patients showed sustained pain relief, improved ankle function, and good radiologic repair tissue quality after a minimum follow-up of 18 years.

Background

Osteochondral lesions of the talus often cause persistent pain and functional limitations, especially when non-operative treatments fail. Surgical options include bone marrow stimulation, autologous chondrocyte implantation, and autologous osteochondral transplantation (AOT). AOT is a single-stage procedure transplanting osteochondral dowels to restore native cartilage and subchondral bone, showing promising short- and mid-term results. However, long-term data assessing the durability and clinical efficacy of AOT remain limited.

Data Highlights

The study included patients aged 16–60 years undergoing AOT between 1997 and 2003 with a minimum follow-up of 18 years. Outcomes assessed included patient-reported scores (AOFAS, FAOS, Tegner, VAS), clinical examination, and MRI using the MOCART 2.0 scoring system. Surgical details such as lesion size, location, and number of osteochondral dowels transplanted were recorded. Postoperative rehabilitation included 6 weeks of non-weight bearing and gradual return to sports by 3 to 6 months.

Key Findings

• Patients undergoing AOT for OLT achieved good to excellent long-term clinical outcomes with sustained pain relief and functional improvement.
• High survival rates of the osteochondral grafts were observed, with low rates of reoperation and failure over nearly two decades.
• MRI evaluation using MOCART 2.0 showed good quality of cartilage repair tissue and restoration of the subchondral bone plate.
• Donor-site morbidity at the ipsilateral knee was minimal, with low pain scores and preserved knee function.
• Return to sports and work activities was generally successful, with most patients reporting minor or no limitations in athletic and occupational performance.
• Correlation analysis indicated that better radiologic repair tissue quality was associated with improved patient-reported outcomes.

Clinical Implications

AOT represents a durable and effective single-stage surgical option for patients with focal OLT who have failed conservative treatment. The procedure restores native cartilage and subchondral bone, resulting in sustained functional improvements and low complication rates. Clinicians should consider AOT especially in lesions larger than 10 mm in diameter where bone marrow stimulation techniques are less effective.

Conclusion

Autologous osteochondral transplantation provides positive long-term clinical and imaging outcomes with high graft survival rates in patients with osteochondral lesions of the talus. This supports its role as a reliable treatment to prevent ankle deterioration and improve quality of life over extended follow-up periods.

References

1. Technical University of Munich Institutional Review Board 2020 -- Study on AOT for OLT
2. Arthrex Inc. -- Osteochondral Autograft Transfer System (OATS®)