Knee-to-Talus osteochondral grafting for talar lesions: Mid-term outcomes of the OATS procedure

Abstract

Background

Talar osteochondral lesions (OCLs), often resulting from ankle trauma, affect the cartilage and subchondral talus bone and frequently require surgical intervention when conservative measures fail. Arthroscopic debridement and microfracture are some of the surgical interventions, leaving many patients with ongoing pain even after extended rehabilitation. The osteochondral autograft transfer system (OATS) offers an alternative by restoring hyaline cartilage using grafts from non-weight-bearing knee regions.

Purpose / Study Design

This retrospective case series evaluated the effectiveness of OATS in improving patient-reported outcomes for patients with postero-medial talar OCL.

Methods

All procedures were performed by a single surgeon across three centres in Western Australia. The donor sites for all autografts were from a non-weight bearing region of the lateral femoral condyle on the ipsilateral side. Pre- and post-operative patient-reported outcome measures were collected.

Results

Thirteen patients underwent OATS for talar OCLs from 2020 to 2024, with mean follow-up of 1.99 years. All had failed prior non-operative management, and over half underwent previous arthroscopic debridement. The average lesion size was 169 mm², requiring 1–3 grafts. AOFAS scores improved significantly from 60.3 to 80.2 (p < 0.0001), with no correlation between score change and age, lesion size, number of plugs, nor previous procedures. Donor site morbidity was low (15.4%), reported only as subjective weakness.

Conclusion

OATS is a safe and effective treatment for talar OCLs unresponsive to conservative or previous arthroscopic surgical management. Low donor site morbidity supports the use of ipsilateral knee harvest. Future studies should incorporate validated PROMs and explore predictive factors for surgical success.

Level of Clinical Evidence

Level 4 – Case Series