Combined allogeneic osteochondral mosaicplasty and high tibial osteotomy for severe talus osteochondral lesions (Hepple Type V): clinical efficacy, inflammatory response and prognostic factors

Background Hepple Type V osteochondral lesions of the talus (OLT) are challenging. This study compared the clinical efficacy and inflammatory response of allogeneic osteochondral mosaicplasty (AOM) combined with high tibial osteotomy (HTO) versus AOM alone for OLT and identified prognostic factors.Methods This retrospective cohort study compared perioperative inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6)], clinical outcomes [Visual Analogue Scale (VAS) pain score, ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, tibiotalar tilt angle (TTA), joint line convergence angle (JLCA)], complications and prognostic factors between AOM alone (n = 263) and AOM+HTO (n = 176) groups.Results The combined group showed lower day 7 VAS, better 12-month ROM, and higher AOFAS and MOCART scores at 3 and 12 months (all p < 0.05). Postoperative CRP, ESR, and IL-6 were transiently higher in the combined group (p < 0.05). At 12 months, the combined group demonstrated greater improvements in TTA and JLCA (both p < 0.001). Complication rates were similar between groups. Multivariate analysis identified older age, higher BMI, diabetes, longer procedure time, delayed full weight-bearing, elevated preoperative IL-6, larger cyst diameter/depth, and central lesion location as factors associated with poor prognosis, while combined treatment was associated with lower odds of poor prognosis.Conclusion In this retrospective cohort, AOM combined with HTO was associated with better short-term outcomes than AOM alone, with an acceptable inflammatory response. However, prospective studies are required to confirm these associations.