Arthroscopic autologous iliac crest cancellous bone grafting for Hepple stage V osteochondral lesions of the talus: a retrospective case series.
10 affiliations
- 1Sports Medicine Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China.
- 2Orthopaedic Department, The Second Hospital of Tangshan, Tangshan, 063000, Hebei, People's Republic of China.
- 3Department of Sports Traumatology, Università Telematica San Raffaele, Via di Val Cannuta, 247, Rome, Italy.
- 4Department of Orthopaedic Surgery, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
- 5Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.
- 6Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
- 7Department of Trauma and Reconstructive Surgery, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle (Saale), Germany. [email protected].
- 8Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy. [email protected].
- 9Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany. [email protected].
- 10Sports Medicine Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China. [email protected].
Abstract
Background
Evidence regarding arthroscopic autologous iliac crest cancellous bone grafting for Hepple stage V osteochondral lesions of the talus (OLTs) remains limited. This study assessed short-term clinical outcomes, postoperative imaging findings, and perioperative characteristics of this technique.Methods
This retrospective case series included 23 patients undergoing arthroscopic autologous iliac crest cancellous bone grafting between March 2020 and July 2024. Preoperative magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated subchondral cystic changes in all lesions, which were classified as Hepple stage V OLTs. The primary outcome was the European Foot and Ankle Society (EFAS) score at final follow-up. Secondary outcomes included the Visual Analogue Scale (VAS) pain score during walking, the American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), 36-Item Short Form Health Survey (SF-36) pain domain score, Tegner score and ankle range of motion (ROM). Postoperative radiographs and available CT scans were reviewed to assess graft position and subchondral healing; MRI findings were also evaluated when available. Operative time, concomitant lateral ligament repair, and complications were documented. Paired comparisons were performed using the paired t-test or Wilcoxon signed-rank test, as appropriate after assessment of normality.Results
Mean follow-up was 21.0 ± 8.7 months (median, 18.0 months; Q1-Q3, 13.0-24.0), and mean lesion area was 1.94 ± 0.38 cm². Median operative time was 75.0 min (Q1-Q3, 67.5-86.0), and five patients underwent concomitant lateral ligament repair. The median EFAS score improved from 9.0 (Q1-Q3, 8.0-10.0) preoperatively to 19.0 (Q1-Q3, 18.0-20.0) at final follow-up (P < 0.001). All other clinical outcome measures also improved significantly (all P < 0.001). Radiographs obtained in all 23 patients demonstrated maintained graft position. Among the 17 patients who underwent postoperative CT, structural graft incorporation was observed in all cases. MRI was obtained in eight selected patients and demonstrated no graft displacement. No major complications were observed. One patient experienced transient mild donor-site pain that resolved with conservative treatment, whereas another had delayed recovery with mild residual ankle pain.Conclusions
Arthroscopic autologous iliac crest cancellous bone grafting was associated with improvements in pain, function, and activity in patients with Hepple stage V OLTs at short-term follow-up. Postoperative CT demonstrated graft incorporation in all patients who underwent CT assessment. These preliminary findings support the feasibility of this technique for appropriately selected cystic lesions, although larger comparative studies with longer follow-up are warranted.
Related
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BibTeX
@article{zhang2026arthroscopic,
title = {{Arthroscopic autologous iliac crest cancellous bone grafting for Hepple stage V osteochondral lesions of the talus: a retrospective case series.}},
author = {Zi-He Zhang and Chong Xue and Chao-Fan Su and Shun-Hong Gao and Francesco Oliva and Nicola Maffulli and Filippo Migliorini and Shi-Ming Feng},
journal = {Journal of orthopaedic surgery and research},
year = {2026},
month = nov,
doi = {10.1186/s13018-026-07356-4},
url = {https://europepmc.org/article/MED/42968155},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Arthroscopic autologous iliac crest cancellous bone grafting for Hepple stage V osteochondral lesions of the talus: a retrospective case series.
AU - Zi-He Zhang
AU - Chong Xue
AU - Chao-Fan Su
AU - Shun-Hong Gao
AU - Francesco Oliva
AU - Nicola Maffulli
AU - Filippo Migliorini
AU - Shi-Ming Feng
PY - 2026
DA - 2026/11/02
JO - Journal of orthopaedic surgery and research
DO - 10.1186/s13018-026-07356-4
UR - https://europepmc.org/article/MED/42968155
AB - Background Evidence regarding arthroscopic autologous iliac crest cancellous bone grafting for Hepple stage V osteochondral lesions of the talus (OLTs) remains limited. This study assessed short-term clinical outcomes, postoperative imaging findings, and perioperative characteristics of this technique.Methods This retrospective case series included 23 patients undergoing arthroscopic autologous iliac crest cancellous bone grafting between March 2020 and July 2024. Preoperative magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated subchondral cystic changes in all lesions, which were classified as Hepple stage V OLTs. The primary outcome was the European Foot and Ankle Society (EFAS) score at final follow-up. Secondary outcomes included the Visual Analogue Scale (VAS) pain score during walking, the American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), 36-Item Short Form Health Survey (SF-36) pain domain score, Tegner score and ankle range of motion (ROM). Postoperative radiographs and available CT scans were reviewed to assess graft position and subchondral healing; MRI findings were also evaluated when available. Operative time, concomitant lateral ligament repair, and complications were documented. Paired comparisons were performed using the paired t-test or Wilcoxon signed-rank test, as appropriate after assessment of normality.Results Mean follow-up was 21.0 ± 8.7 months (median, 18.0 months; Q1-Q3, 13.0-24.0), and mean lesion area was 1.94 ± 0.38 cm². Median operative time was 75.0 min (Q1-Q3, 67.5-86.0), and five patients underwent concomitant lateral ligament repair. The median EFAS score improved from 9.0 (Q1-Q3, 8.0-10.0) preoperatively to 19.0 (Q1-Q3, 18.0-20.0) at final follow-up (P < 0.001). All other clinical outcome measures also improved significantly (all P < 0.001). Radiographs obtained in all 23 patients demonstrated maintained graft position. Among the 17 patients who underwent postoperative CT, structural graft incorporation was observed in all cases. MRI was obtained in eight selected patients and demonstrated no graft displacement. No major complications were observed. One patient experienced transient mild donor-site pain that resolved with conservative treatment, whereas another had delayed recovery with mild residual ankle pain.Conclusions Arthroscopic autologous iliac crest cancellous bone grafting was associated with improvements in pain, function, and activity in patients with Hepple stage V OLTs at short-term follow-up. Postoperative CT demonstrated graft incorporation in all patients who underwent CT assessment. These preliminary findings support the feasibility of this technique for appropriately selected cystic lesions, although larger comparative studies with longer follow-up are warranted.
SN - 1749-799X
ER -