Cartilage allograft transplantation for challenging medial talar dome osteochondral defects: A retrospective case series utilizing medial malleolar osteotomy

doi:10.5312/wjo.v17.i5.115855

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. May 18, 2026; 17(5): 115855
Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.115855

Cartilage allograft transplantation for challenging medial talar dome osteochondral defects: A retrospective case series utilizing medial malleolar osteotomy

Mohamed M Elalfy, Osama M Embaby, Ahmed N Aladl, Mohamed Abdelrazek, Khaled Youssef, Orjwan Abulaban, Mohammed H Abushal

Mohamed M Elalfy, Mohamed Abdelrazek, Department of Orthopedic Surgery, Mansoura University Hospitals, Dakahlia 35516, Mansoura, Egypt

Mohamed M Elalfy, Department of Orthopedic Surgery, Andalusia Hospitals, Jeddah 22341, Makkah Al Mukarramah, Saudi Arabia

Osama M Embaby, Department of Orthopedic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B66 2QT, United Kingdom

Osama M Embaby, Department of Orthopedic Surgery, Damietta University, New Damietta 34517, Egypt

Ahmed N Aladl, Department of Orthopedic Surgery, Sana Klinikum Coburg, Ketschendorfer 96450, Germany

Khaled Youssef, Department of Orthopedic Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom

Orjwan Abulaban, Department of Orthopedic Surgery, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia

Mohammed H Abushal, Department of Orthopedic Surgery, University of Tabuk, Tabuk 71491, Saudi Arabia

Co-first authors: Mohamed M Elalfy and Osama M Embaby.

Author contributions: Elalfy MM designed the research and performed the surgeries and clinical work; Elalfy MM and Embaby OM supervised the study, and they contributed equally to this manuscript and are co-first authors; Elalfy MM, Embaby OM, Aladl AN, Abdelrazek M, Youssef K, Abulaban O, and Abushal MH contributed to interpretation of data and critical revision of the manuscript for important intellectual content; Embaby OM curated and analyzed the data and wrote the original draft. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.

AI contribution statement: AI-assisted tools were used only for language polishing, grammar checking, and improving the clarity/readability of the manuscript.

Institutional review board statement: The requirement for formal ethical approval was waived by the Institutional Review Board of Red Crescent Hospital (Mansoura, Egypt), as this was a retrospective case series of anonymized data. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent statement: The requirement for individual informed consent was waived by the Institutional Review Board of Red Crescent Hospital (Mansoura, Egypt), as this retrospective case series used anonymized clinical and imaging data.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Mohamed M Elalfy, MD, Foot and Ankle Surgery Consultant, Department of Orthopedic Surgery, Mansoura University Hospitals, El Gomhoureya Street, Dakahlia 35516, Mansoura, Egypt. drmelalfy@mans.edu.eg

Received: October 28, 2025
Revised: November 17, 2025
Accepted: January 29, 2026
Published online: May 18, 2026
Processing time: 203 Days and 9.4 Hours

Abstract

BACKGROUND

Osteochondral defects (OCDs) of the medial talar dome represent a complex surgical challenge due to limited arthroscopic accessibility. Medial malleolar osteotomy allows optimal access for cartilage restoration in challenging medial talar dome lesions. This case series examines the clinical and radiographic outcomes of treating medial talar OCDs with the cartilage allograft following arthroscopic evaluation and medial malleolar osteotomy.

AIM

To evaluate the clinical and radiographic outcomes of treating large, symptomatic medial talar dome OCDs using a single-stage technique combining medial malleolar osteotomy, bone marrow aspirate augmentation, and cartilage allograft transplantation. We assessed functional improvement using validated outcome measures and graft integration using magnetic resonance imaging (MRI)-based Magnetic Resonance Observation of Cartilage Repair Tissue scoring at midterm follow-up.

METHODS

A retrospective analysis was conducted on 23 consecutive patients (mean age 35.4 years; 15 males, 8 females) presenting with symptomatic, isolated OCDs of the medial talar dome (Raikin zone 4) after failed conservative management. Each patient underwent arthroscopic evaluation followed by medial malleolar osteotomy, systematic defect preparation with drilling, bone marrow aspirate application, and the cartilage allograft implantation secured with fibrin glue. Clinical assessment utilized the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, Short Form-36, and Visual Analogue Scale for pain at mean 24-month follow-up. Pre and post operative radiographic and MRI was used to evaluate graft integration and fill.

RESULTS

The mean American Orthopaedic Foot and Ankle Society score demonstrated improvement from 54.2 ± 12.1 preoperatively to 88.7 ± 7.5 postoperatively (P < 0.001). Mean Visual Analogue Scale pain scores decreased from 6.4 ± 1.0 to 1.5 ± 1.2 (P < 0.001). Short Form-36 scores exhibited significant enhancement across all domains. Eighteen of 23 patients (80%) achieved good to excellent outcomes. Five patients experienced residual mild pain, though substantially improved from preoperative status. Postoperative MRI revealed complete or substantial graft fill and integration in 20 of 23 patients (87%). Complications included one delayed union of the osteotomy and two superficial wound complications which resolved with conservative management.

CONCLUSION

Treatment of symptomatic OCDs of the medial talar dome with cartilage allograft following medial malleolar osteotomy represents a safe and effective procedure, yielding significant clinical and radiographic improvements at midterm follow-up. This single-stage procedure offers a promising therapeutic option for these challenging lesions. Long-term follow-up remains necessary to assess repair durability and outcomes.

Keywords: Osteochondral lesions; Talus; Medial malleolar osteotomy; Cartilage allograft; Fibrin glue; Case series

Core Tip: This retrospective study evaluated 23 patients with symptomatic osteochondral defects of the medial talar dome treated using cartilage allograft transplantation following medial malleolar osteotomy. The technique combined defect drilling, bone marrow aspirate application, and fibrin glue fixation to enhance graft stability and integration. Significant improvements were achieved in American Orthopaedic Foot and Ankle Society score, Visual Analogue Scale for pain, and Magnetic Resonance Observation of Cartilage Repair Tissue score. This single-stage approach provides a safe, effective, and biologically supported solution for large medial talar dome osteochondral defects.