Autologous Osteoperiosteal Transplantation Versus Autologous Osteochondral Transplantation for Large Cystic Osteochondral Lesions of the Medial Talus: 2-Year Results From a Prospective Randomized Controlled Trial

BACKGROUND: Both autologous osteochondral transplantation (AOCT) and autologous osteoperiosteal transplantation (AOPT) are available for large cystic osteochondral lesions of the talus (OLTs). However, there is a lack of valid prospective evidence directly comparing the efficacy between AOPT and AOCT. PURPOSE/HYPOTHESIS: The purpose of this study was to compare the efficacy and safety of AOPT versus AOCT in patients with large cystic OLTs (>8 mm in cystic diameter) at 2 years of follow-up. It was hypothesized that compared with AOCT, AOPT would be associated with noninferior efficacy and less donor site morbidity in the treatment of large cystic OLTs. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: This was a prospective randomized controlled trial of 70 consecutive patients who underwent AOPT or AOCT between May 2018 and July 2022. Perioperatively, patient characteristics, clinical data, and surgical records were collected. Clinical outcomes were assessed using patient-reported outcome measures, including the visual analog scale for pain (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and the ankle activity score (AAS), at 3, 6, 12, and 24 months postoperatively. Radiological outcomes were evaluated according to the magnetic resonance observation of cartilage repair tissue (MOCART) score. The arthroscopic examination was performed using the International Cartilage Repair Society (ICRS) score. Donor site morbidity in both groups was recorded over the 24-month follow-up period. RESULTS: A total of 67 patients completed 2-year follow-up: 33 in the AOPT group and 34 in the AOCT group. Baseline characteristics were comparable. No significant differences were observed between the 2 groups in terms of the VAS, AOFAS, and AAS scores throughout the 2-year follow-up period. The AOCT group exhibited higher MOCART and ICRS scores within the first 12 months after surgery. However, by 24-month follow-up, the MOCART score in the AOPT group had reached a level comparable with that in the AOCT group. Additionally, the AOPT group had a lower incidence of donor site morbidity and lower VAS scores across the follow-up period compared with the AOCT group. CONCLUSION: This trial demonstrated that at 2-year follow-up, AOPT was noninferior to AOCT with regard to clinical outcomes and cartilage repair quality in patients with large cystic OLTs. Long-term follow-up is needed to confirm these results. REGISTRATION: NCT03347877 (ClinicalTrials.gov).