Treatment of osteochondral lesions of the talus: a systematic review.

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Abstract

[Indexed for MEDLINE] 13. J Orthop Surg Res. 2025 Oct 14;20(1):892. doi: 10.1186/s13018-025-06214-z. Mid- to long-term outcomes of osteochondral lesions of the talus repair: a systematic review. Wen J(1), Syed B(2), Abed I(2), Shehabat M(2), Akhtar M(2), Razick D(2), Alam A(3), Kreuelen C(4). Author information: (1)California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, United States. jdoub2009@berkeley.edu. (2)California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, United States. (3)University of California, 1 Shields Ave, Davis, CA, 95616, United States. asalam@ucdavis.edu. (4)Department of Orthopaedic Surgery, University of California, Davis, 4860 Y St #1700, Sacramento, CA, 95817, United States. Erratum in J Orthop Surg Res. 2026 Feb 26;21(1):164. doi: 10.1186/s13018-026-06692-9. BACKGROUND: Osteochondral lesions of the talus (OLTs) involve damage to the articular cartilage and underlying bone, posing a therapeutic challenge due to the limited intrinsic healing capacity of cartilage. This review aims to provide mid- to long-term follow-ups for joint preservation procedures for OLTs through analysis of patient-reported outcomes (PROs), rates of return to activity/sport/work, and survival rates/complications. METHODS: The guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed to perform this systematic review in PubMed, Embase, and Cochrane Library for studies evaluating surgical treatment for OLTs at a minimum 5-year follow-up. Quality and risk of bias assessment were completed using the Methodological Index for Non-Randomized Studies criteria. RESULTS: 43 studies with a total of 2721 patients with an age range of 23.9 to 47.7 years, defect size of 0.9 to 29.1 cm2, and follow-up of 5 to 24.1 years were included. Survival rates, defined as no revision surgeries, at the latest follow-up, for bone marrow stimulation (8 studies), autologous chondrocyte implantation (6 studies), matrix-associated chondrocyte implantation (3 studies), autologous matrix-induced chondrogenesis (AMIC) (2 studies), OATS (7 studies), and bone marrow aspirate concentrate were 87.4 to 100%, 75 to 100%, 55.6 to 100%, 84.2 to 92.1%, 56.4 to 100%, and 90.1 to 95.3%. respectively. Survival rates for the other techniques, reported in separate studies, were biphasic bioresorbable scaffold (100%), matrix-induced stem cell transplantation (100%), AMIC plus peripheral blood concentrate (96.9%), microfracture plus platelet-rich plasma and hyaluronic acid (91.23%), autologous tibia osteoperiosteal graft (86.67%), arthroscopic lift-drill-fill-fix (66.7%), and particulates juvenile allograft cartilage implantation (53.5%). The majority of studies demonstrated significant PRO improvements (p