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

Background: Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat. Purpose: To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery. Results: In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 +/- 4.8 preoperatively to 93.7 +/- 4.6;t= -13.708;P< .0001). The 1- and 2-year AOFAS scores were similar (t= -0.755;P= .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 +/- 0.67 preoperatively to 0.47 +/- 0.69;t= 18.974;P< .0001). The 1- and 2-year VAS scores were similar (t= -0.705;P= .455), as were the 1- and 2-year MOCART scores (64.2 +/- 7.5 vs 67.4 +/- 7.3, respectively;t= -1.312;P= .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients. Conclusion: Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.