Osteochondral Lesion of Talus Treated by Mosaicplasty from the Knee as Donor Site, Orthopedic Surgery Ward. Tobruk Medical Center, L

Background: Osteochondral lesions of the talus (OLT) represent a frequent cause of chronic ankle pain and disability, particularly in young and active individuals. Conservative management often provides limited benefit in advanced cases, making surgical treatment a necessary option. Mosaicplasty, which involves the transfer of autologous osteochondral grafts, has gained recognition as an effective method for restoring articular cartilage integrity. This study aimed to evaluate the clinical outcomes of mosaicplasty in patients with advanced talar dome lesions. Material and Methods: A descriptive case series was conducted at the Orthopaedic and Traumatology Department of Tobruk Medical Centre between January 2010 and December 2022. Twenty-one patients with MRI-confirmed Bristol/Hepple grade ≥3 OLT were included. The cohort consisted of 18 males and 3 females, with a mean age of 30 years (range: 20–41). Lesions were right-sided in 12 patients and left-sided in 9. Based on lesion site, 15 were anteromedial and 6 were anterolateral. Seven patients were aged 20–30, thirteen were 30–40, and one was over 41. Medial malleolar osteotomy was performed in 5 patients. Fifteen cases had a history of sports-related ankle trauma. Exclusion criteria were diabetes mellitus, neglected or chronic ankle injuries, arthritis, rheumatologic or metabolic disease, prior ankle surgery, or age above 45. The follow-up period ranged from 3 to 4 years. Results: Most patients experienced significant pain relief, improved ankle motion, and functional recovery. Outcomes were slightly better in the anteromedial group compared to anterolateral lesions. Younger patients and those with acute sports injuries achieved more favorable results. No major complications, graft failure, or severe donor site morbidity occurred. Conclusion: Mosaicplasty is a safe and effective surgical technique for advanced talar dome OLT, providing consistent pain reduction, improved joint function, and successful return to activity. Larger, long-term controlled studies are warranted to confirm these findings.