Paper 14: Talar Osteochondritis Treatment with Arthroscopic Composite Cancellous Autograft and Morselized Cartilage Allograft: Improved Clinical Outcomes and High Rate of Return to Sport

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Objectives: To evaluate the patient-reported outcomes (PROs), return to activity, and osteochondral healing based upon magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score following arthroscopic layered cancellous autograft bone and morselized allograft cartilage (composite) grafting for osteochondritis dissecans (OCD) of the talus in adolescent patients. Methods: An IRB-approved review of demographic and operative data, imaging, and prospectively collected preoperative and postoperative PROs was accomplished. Consecutive patients treated for talar OCD (indicated for symptomatic, unstable lesions) with arthroscopic debridement, cancellous autografting, and implantation of morselized allograft cartilage (BioCartilage; Arthrex, Naples, FL) grafting (January 2015 - October 2022) with a minimum one year follow up were included. The MOCART 2.0 score was employed to assess postoperative MRIs. Results: The study population consisted of 20 ankles with talar OCD. The average age at presentation was 14.5 ± 2.0 years with an average follow up of 1.7 years ± 10.6 months (range: 1-4.2 years). Postoperatively, 81.3% of athletes reported a return to their preoperative sport after an average of 8.5 ± 3.0 months. There was a statistically significant increase across all five domains of the FAOS from pre- and post-treatment. All lesions demonstrated stable lesion filling with incorporated bony elements below the augmented fibrocartilage surface. A mean MOCART score of 66.7 ± 15.0 reflected appropriate contour and stability of surface fibrocartilage with some signal irregularity of the fibrocartilage matrix. There was no significant correlation between MOCART scores and PROs (P > 0.05). Conclusions: Statistically significant improvement in PROs and high rates of return to sport were achieved following composite grafting to treat unstable talar OCD in adolescent athletes. The authors recommend this technique as an effective strategy for addressing both the osseous and chondral components of the defect with minimal morbidity.

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