# Clinical and functional outcomes of arthroscopic autologous collagen‐induced chondrogenesis (ACIC) for osteochondral lesions of the talus: A retrospective case series

## TL;DR

This study shows that arthroscopic ACIC with a collagen scaffold improves outcomes for ankle cartilage lesions, with significant pain and function improvements over time.

## Contribution

The study evaluates the arthroscopic ACIC technique using an injectable collagen scaffold for treating talus osteochondral lesions.

## Key findings

- All clinical scores significantly improved post-surgery compared to preoperative values.
- Patients met or exceeded expectations for pain relief and functional recovery.
- No major complications or revision surgeries occurred in the study group.

## Abstract

The aim of this retrospective study was to assess the clinical outcomes for osteochondral lesions of the talus (OLT) treated with all arthroscopic autologous collagen‐induced chondrogenesis (ACIC) technique using an injectable collagen scaffold combined with microfractures.

Between 2020 and 2023, 21 patients with Hepple Grade II–IV OLTs underwent arthroscopic ACIC technique using an injectable collagen scaffold combined with microfractures. Concomitant intra‐articular pathologies identified during arthroscopy were addressed simultaneously. Clinical outcomes, including Visual Analogue Scale (VAS), Foot Functional Index (FFI) and Foot and Ankle Ability Measure–Sports subscale (FAAM‐SS), were assessed preoperatively and at the latest follow‐up. Patient expectations, complications and return‐to‐activity times were also recorded at final follow‐up.

The mean follow‐up was 37.4 ± 20.7 (range, 13–68) months. The mean defect size was 76.6 ± 33.6 mm2 (range, 35–135 mm2). All clinical scores significantly improved compared with preoperative values (p < 0.05): VAS improved from 3.17 ± 1.82 (95% confidence interval [CI]: 2.34–4.00) to 0.27 ± 0.48 (95% CI 0.05–0.49), FFI from 40.90 ± 25.42 (95% CI: 29.33–52.47) to 4.02 ± 3.86 (95% CI: 2.26–5.78) and FAAM‐SS from 37.81 ± 28.51 (95% CI: 24.83–50.79) to 86.11 ± 13.75 (95% CI: 79.85–92.37). All patients reported that their expectations were met or exceeded regarding pain relief, functional recovery and return to daily activities. Associated intra‐articular pathologies were identified in all patients; in 17 patients (80.9%), a concomitant lateral ligament injury was observed and treated with arthroscopic repair. No major complications or revision surgeries occurred.

Arthroscopic ACIC with an injectable atelocollagen scaffold was feasible and safe in this series of Hepple II–IV OLT, yielding improvements in patient‑reported outcomes at a mean 37.4‑month follow‑up. Due to design limitations and frequent concomitant ligament stabilization, these findings should be considered hypothesis‑generating rather than definitive evidence of cartilage regeneration.

Level IV, retrospective case series.