Osteochondral lesions of the talus (OLTs) are common pathologies, associated to chronic pain and disability. Currently, there is no agreed gold standard for surgical treatment of OLTs, due to lack of superiority trials. Aim: Compare the post operative outcomes of osteochondral autologous transplantation (OATS) and matrix associated stem cell transplantation (MAST), as primary and revision procedures Methods: Prospective study of OATS and MAST from 2013 to 2023, in a single surgeons practice Primary study outcome: rate of revision. Secondary outcomes: PROMS (VAS and FAOS), complications and return to sports. Data collected via chart, radiological review, and telephonic survey. Inclusion criteria: aged 16 years and above; OLTs greater than 10mm2, Primary and Revision. Exclusion criteria: Unable to/Refused consent (N=1), Rheumatological joint disease (N=1). Degenerative joint. Lost to follow up. Statistical analysis with Chi-squared test, Fischers exact test, Wilcoxon sum test, and linear regression. Results: N=90. Equal distribution of OATS being used for primary and for revision (50% (16) /50% (16)), MAST had a slight prevalence of revision over primary (55% revision (32) / 45% primary (26) p 0.6). There was a significant association between prior surgery and the need for a revision procedure in the MAST cohort. (β = 1.491, SE = 0.562, p = 0.008). Return to sport was seen in 90% of the OAST and 67% of MAST (p 0.11). There was statistically significant improvement in PROMs for both techniques (VAS and FAOS), but no significant change between the outcomes in primary versus revision surgeries. Conclusion: OATS is an appropriate technique for managing OLTs, both as a primary and salvage procedure, with significant improvement of PROMS (VAS and FAOS), and elevated rate of return to sports (90%). MAST as a primary intervention showed similar outcomes to those of OATS, but poorer outcomes as a salvage procedure, with higher rates of revision thereafter (p .01).

Introduction

Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST.