Arthroscopic Autologous Matrix-induced Chondrogenesis for Osteochondral Lesions of the Talus: Functional Recovery and Return to Activity at Midterm Follow-up

may be severely limited by pain, catching, and loss of ankle motion.Indeed, approximately 1 in 4 patients fail to return to their preinjury activity levels after standard bone marrow stimulation procedures. 4 This observation highlights a critical need for surgical strategies that not only alleviate pain but also restore function under repetitive mechanical load. HigHligHts Arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) provides significant and durable functional improvement in patients with osteochondral lesions of the talus (OLT), with marked gains in pain, activity, and walking subscores. Return to activity and sport was consistently achieved, addressing the most clinically relevant outcome for active and athletic patients. Compared with microfracture, OATS, and open AMIC, the arthroscopic AMIC technique offers equal or superior results, with reduced morbidity and faster recovery. This is one of the largest midterm cohorts (n = 94, mean 44 months) reporting outcomes of AT-AMIC in the ankle. Findings support AT-AMIC as a minimally invasive, biologically effective, and clinically reliable option, potentially establishing it as a gold standard for talar cartilage repair. introductionOsteochondral lesions of the talus (OLT) are a well-recognized cause of chronic ankle pain, swelling, and functional impairment, particularly among young and active individuals.These lesions typically occur after ankle trauma or repetitive microinjury, and if untreated, may progress to early osteoarthritis, ultimately restricting physical activity and diminishing quality of life. 1]3 Exercise and physical activity are central to health, social interaction, and personal identity.Yet in patients with symptomatic OLT, the ability to walk long distances, run, or participate in sport