Foot and Ankle International - 2026-03-30 - Journal Article
Autologous Osteoperiosteal Transplantation Provides Comparable Clinical and Radiologic Outcomes for Lateral and Medial Large Cystic Osteochondral Lesions of the Talus: A Propensity Score-Matched Comparative Analysis.
Yang S, Liu Z, Chen Z, Zhu C, Hu F, Shao Q, Pan J, Xie X, Jiang D, Jiao C, Hu Y, Shi W, Guo Q
Topics
Key Takeaway
AOPT for large cystic OLTs yields equivalent FAOS improvement (~35 points) and MOCART 2.0 scores (~73) regardless of lesion laterality at mean 84.6 months follow-up.
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Summary
This study asked whether lesion laterality affects outcomes of AOPT for large cystic OLTs, comparing 22 propensity score-matched lateral versus medial lesion patients treated between 2010 and 2023. Both groups achieved significant FAOS improvement (lateral: 53.4→87.2; medial: 51.1→89.7, both P<.001) with no intergroup difference in any clinical or radiologic metric. MOCART 2.0 scores were nearly identical (73.8 vs 73.0) and did not correlate with clinical outcomes.
Key Limitation
The wide follow-up standard deviation (±45.9 months) and small matched cohort (n=22 per group) limit the ability to detect differences in late failure or revision rates between laterality groups.
Original Abstract
BACKGROUND
Autologous osteoperiosteal transplantation (AOPT) is a promising treatment for large cystic osteochondral lesions of the talus (OLTs), but the influence of lesion laterality remains unclear. The purpose of this study was to compare the clinical and radiologic outcomes of lateral vs medial large cystic OLTs treated with AOPT.
METHODS
Patients with lateral or medial large cystic OLTs who underwent AOPT between 2010 and 2023 were retrospectively reviewed. Patients were propensity matched in 1:1 ratio on sex, age, body mass index, affected side, and lesion profiles (area, depth, volume). Clinical outcomes were assessed using the visual analog scale for pain (VAS), the Foot Ankle Outcome Score (FAOS), and the ankle activity score (AAS). The final FAOS score was designated as the primary outcome measure. Radiologic outcomes were evaluated using the MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 ankle score.
RESULTS
A total of 22 matched patients per group were included, with a mean follow-up of 84.6 ± 45.9 months. The lateral group comprised 20 males and 2 females (mean age, 40.4 ± 11.2 years), whereas the medial group included 18 males and 4 females (mean age, 38.0 ± 8.4 years). Both groups demonstrated significant improvements in total FAOS scores (lateral: 53.4 ± 13.8 to 87.2 ± 10.1, P < .001; medial: 51.1 ± 12.6 to 89.7 ± 8.4, P < .001) and in all secondary clinical outcomes at final follow-up (all P < .001), with no intergroup differences (all P > .05). Similarly, there were no significant differences in the total MOCART 2.0 ankle score (73.8 ± 10.7 vs 73.0 ± 9.9; nonsignificant) or in any of its individual subcomponents.
CONCLUSION
This cohort study demonstrated that AOPT yields comparable mid‑ to long‑term clinical and radiologic outcomes for medial and lateral large cystic OLTs, and that radiologic results were not significantly associated with clinical outcomes.