All‐Arthroscopic Autologous Cancellous Bone Transplantation Achieves Favorable Functional Improvements and Radiographic Recovery in Large Cystic Osteochondral Lesions of the Talus at a Minimum 12‐Month Follow‐Up

Purpose To evaluate short‐term clinical and radiographic outcomes of all‐arthroscopic autologous cancellous bone transplantation in addressing large cystic osteochondral lesions of the talus with cyst diameter ≥10 mm and cyst depth ≥6 mm. Methods A retrospective analysis was carried out among consecutive patients who underwent arthroscopic cancellous bone transplantation by 1 senior surgeon between January 2020 and September 2023 using autografts from the ipsilateral Gerdy's tubercle. A minimum follow‐up of 12 months was required for inclusion. Patient‐reported outcome measures were evaluated preoperatively and at the latest follow‐up, including the American Orthopaedic Foot visual analogue scale, from 7.9 ± 0.8 to 2.0 ± 1.0; ankle activity score, from 2.3 ± 1.1 to 4.0 ± 1.4; and Foot and Ankle Outcome Score, from 59.0 ± 7.8 to 83.1 ± 12.1 ( P < .001 for all). Subjective satisfaction was 8.9 ± 1.1. Percentages of patients exceeding minimal clinically important differences of the American Orthopaedic Foot & Ankle Society, visual analogue scale, ankle activity score, and Foot and Ankle Outcome Score were 97.8%, 100.0%, 75.6%, and 88.9%, respectively. Return‐to‐sports rate was 64.5%, and 32.3% resumed preinjury level. The Magnetic Resonance Observation of Cartilage Repair Tissue score was 80.8 ± 12.0 at 19‐month follow‐up, with complete filling of the defects observed in 71.8% and complete integration in 79.5% patients. Conclusions In treatment of osteochondral lesions of the talus with large subchondral cysts, all‐arthroscopic autologous cancellous bone transplantation showed favorable clinical and radiologic outcomes at a minimum 12‐month follow‐up, achieving significant improvements in patient‐reported outcome measures and a mean Magnetic Resonance Observation of Cartilage Repair Tissue score of 80.8, although the return‐to‐sports rate remained modest at 64.5%. Level of Evidence Level IV, retrospective case series.