Osteochondral Autograft Transplantation Coupled With Platelet-Rich Plasma and Hyaluronic Acid Injections Can Yield Favorable Outcomes in Patients With Osteochondral Lesions of the Talus

George A Rublev; Nivedita Pant; Mohamed Ahmed Mohamed; Tamaz Tamazishvili; Giorgi Khokhashvili; Irakli Gogua; Irakli Kartozia; Giorgi Zimlitski; George Loria; Vazha Gaprindashvili; Mikheil Zimlitski; Levan Natchkebia

doi:10.1016/j.asmr.2025.101206

Osteochondral Autograft Transplantation Coupled With Platelet-Rich Plasma and Hyaluronic Acid Injections Can Yield Favorable Outcomes in Patients With Osteochondral Lesions of the Talus

Arthrosc Sports Med Rehabil. 2025 Jun 26;7(5):101206. doi: 10.1016/j.asmr.2025.101206. eCollection 2025 Oct.

Affiliations

¹ From Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia.
² AIETI David Tvildiani Medical University, Tbilisi, Georgia.

Abstract

Purpose: To evaluate the outcomes of patients who had osteochondral lesions of the talus treated with osteochondral allograft transplants combined with platelet-rich plasma (PRP) and hyaluronic acid (HA).

Methods: We aimed to investigate the outcomes of patients who underwent osteochondral autograft transplantation surgery (OATS) from 2015 to 2022. The inclusion criteria for patients to undergo OATS included a defect size greater than 5 mm and failure of conservative management. The preoperative and postoperative visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded and subsequently analyzed using a paired t test. We also performed cohort-specific analyses that included the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit. PRP injections were administered at 8 weeks postoperatively and were given every 2 weeks, for 3 total injections. HA was injected once every 6 months for the following 2 years. The minimum follow-up time was 2 years.

Results: At the 12-month follow-up, all 19 patients reported a mean increase in the VAS score of 33.40 (95% confidence interval, 30.9-35.8). The average age was 31 years, and there were 12 male and 7 female patients. Of the 19 patients, 17 reported no restriction of motion, whereas the other 2 patients reported some restriction of dorsiflexion. Ankle function based on the AOFAS scoring system showed good to excellent results in 18 of 19 cases (94%), with no long-term donor-site morbidity and a mean increase of 37.49 (95% confidence interval, 34.7-40). Hardware removal of lag screws was conducted at 12 months after initial surgery; all cases resulted in union of the malleolar osteotomy. The average follow-up time was 3 years.

Conclusions: Combining OATS with PRP-HA injections can yield promising results for patients with osteochondral lesions of the talus, showing significant improvement in VAS and AOFAS scores postoperatively.

Level of evidence: Level IV, therapeutic case series.