Autologous costochondral transplantation in the treatment of Hepple V osteochondral lesions of talus: a retrospective analysis

To investigate the surgical technique and therapeutic effect of autologous costochondral transplantation (ACT) in patients with Hepple V osteochondral lesions of the talus (OLT) and to compare both methods with osteoperiosteum transplantation (OPT). Clinical data from 53 patients (53 ankles) with Hepple V OLT admitted to Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital between February 2020 and February 2022 were retrospectively analyzed, including 27 ankles treated with ACT and 26 with OPT. General information, operative time, and hospitalization duration were recorded. Preoperative and final follow-up assessments used the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale (FAAM-ADL) and sports subscale (FAAM-Sp), the EuroQol-Visual Analogue Scale (EQ VAS), and the Magnetic Resonance Observation of Cartilage Repair Tissue 2.0 (MOCART 2.0) to evaluate efficacy and function, verify whether clinical satisfaction with ACT exceeded that of OPT, and document related complications during follow-up. No statistically significant differences in baseline characteristics and scores were observed between the two groups preoperatively. At final follow-up, FAAM-ADL, FAAM-Sp, and EQ VAS scores in both groups were significantly higher than preoperative values ( P < 0.05). The mean MOCART 2.0 scores in the ACT group at final follow-up showed significant improvement compared with 12 months postoperatively ( P < 0.05), whereas no such difference was observed in the OPT group. Postoperative scores at each follow-up point favored the ACT group over the OPT group. Three patients (11.1%) in the ACT group and two patients (7.7%) in the OPT group underwent removal of internal fixation; one patient experienced poor healing of the surgical incision. No complications, such as neurovascular injury, non-union, or delayed union, were reported in either group. Compared with OPT, ACT showed superior functional outcomes, clinical efficacy, higher satisfaction rates, fewer complications, and quicker early mobilization. Level IV, retrospective cohort study.