Particulated Autologous Cartilage with Platelet-Rich Plasma for Osteochondral Lesions of the Talus in Athletes: Return to Sport and Functional Outcomes at 12 Months.

Abstract

Osteochondral lesions of the talus (OLT) are common in athletes and may compromise performance. Single-stage autologous cartilage procedures have emerged as alternatives to microfracture and osteochondral transplantation. To evaluate return-to-sport (RTS) outcomes and functional results after particulated autologous cartilage combined with platelet-rich plasma (PACI-PRP) in athletes with symptomatic OLT. Case series, Level IV. Fifty-three athletes (mean age 28.8±11.4 years, 66% male) with symptomatic OLT >150 mm² underwent PACI-PRP via arthroscopy (83%) or arthrotomy with malleolar osteotomy (17%). Clinical outcomes (AOFAS, VAS, FADI, Karlsson) were assessed at 12 months. RTS metrics included time to return, competitive level achieved, and continuation at one year. All scores improved significantly (p < 0.001): AOFAS 72→86 (+14 points), VAS 5.9→2.0 (-3.9 points), FADI 66→84 (+18 points), Karlsson 78→93 (+15 points). MCID achievement ranged from 75% to 94%. Forty-two of 52 athletes (81%, 95% CI: 68-90) returned to sport at median 32 weeks; 65% reached preinjury level. Four patients (8%) required reoperation for complications. PACI-PRP demonstrated promising short-term effectiveness with high RTS rates and significant functional improvements in athletes with OLT >150 mm². As a single-stage, fully autologous procedure, PACI-PRP may offer potential advantages, though longer follow-up and comparative studies are needed to establish durability and precise indications. IV (Case series).