Large osteochondral lesions of the talus (OLTs) in the chronic phase remain challenging to manage due to degeneration of the osteochondral fragment and underlying subchondral bone defects, which often make conventional fixation techniques difficult to perform. Although various surgical approaches—including autologous osteochondral transplantation, chondrocyte implantation, and structural allografting—have been employed, each carries limitations such as the requirement for an additional donor‐site harvest, the need for staged procedures, or limited graft availability. We report the case of a 19‐year‐old male with a chronic lateral OLT unresponsive to conservative treatment. Imaging revealed a large, multifragmented, and detached osteochondral fragment unsuitable for fixation. Surgical treatment was performed under ultrasound‐guided peripheral nerve block and involved osteochondral reconstruction using an autologous graft harvested from a large osteophyte at the ipsilateral anterior tibial plafond. The graft was carefully shaped to match the articular contour of the defect and fixed with three bioabsorbable pins. The postoperative course was uneventful, and the patient returned to preinjury levels of sports activity. At 19‐month follow‐up, he remained symptom‐free, with excellent scores on clinical outcome scales and the self‐administered foot evaluation questionnaire. Imaging confirmed successful graft integration and joint congruity, with no signs of graft resorption or implant‐related complications. This case highlights the potential utility of osteophyte‐derived autologous grafting as a single‐stage, minimally invasive alternative for large OLTs, particularly when the native osteochondral fragment is nonviable and an appropriately sized osteophyte is available. This technique may reduce overall surgical invasiveness by avoiding the need for graft harvesting from distant donor sites, offering a promising treatment option in selected cases.
Ikuta et al. (2026) studied this question.