Comparative study of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting for the treatment of osteochondral lesions of the talus.

Background: Surgical management methods for Hepple IV-V osteochondral lesions of the talus (OLT) are diverse. This study aimed to compare the clinical efficacy of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting in the treatment of medial Hepple IV-V OLT.

Methods: A retrospective analysis of clinical data from patients who underwent surgical treatment for Hepple IV-V OLT (2020-2023) was conducted. A total of 37 patients were included, with 17 receiving arthroscopic autologous cancellous bone grafting (Group A) and 20 receiving medial malleolar osteotomy combined with autologous periosteal iliac bone grafting (Group B). Compared the surgical time of the two groups; the visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and ankle joint mobility were used preoperatively, and at 3 months and 1 year postoperatively to assess clinical efficacy; the magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 ankle scores were evaluated at early postoperatively and 1 year postoperatively to assess cartilage repair.

Results: The surgical time for Group A was significantly shorter than Group B (P < 0.05). At 3 months and 1 year postoperatively, both groups showed a significant improvements in VAS scores, AOFAS scores, and ankle joint mobility compared to preoperative levels (P < 0.05). At 3 months postoperatively, Group A had significantly higher AOFAS scores and ankle joint mobility than Group B (P < 0.05), while there was no statistically significant difference in VAS scores between the two groups (P > 0.05). At 1 year postoperatively, no significant differences in any of the assessed parameters were found between the two groups (P > 0.05). The MOCART 2.0 ankle scores at 1 year postoperatively were significantly higher than early postoperatively for both groups (P < 0.05), with no significant differences between the two groups (P > 0.05).

Conclusion: Arthroscopic autologous cancellous bone grafting showed superior early functional recovery at the 3-month follow-up compared to medial malleolar osteotomy combined with autologous periosteal iliac bone grafting, with shorter surgical time and avoiding osteotomy. Both surgical methods were able to relieve patients' pain, restore function, and improve cartilage repair.

Level Of Evidence: III, retrospective comparative study.