100

Introduction The use of mosaicplasty to perform autologous osteochondral grafts in the treatment of osteochondral lesions of the talar dome (OLTD) is an increasingly widespread technique. Although it suffers from a reputation for associated morbidities, the medium and long-term results have in reality been little analyzed. Main objective The main objective of our study was to evaluate the results of mosaicplasty, and to determine the poor prognostic factors likely to modify its indication, with the hypothesis of it being an effective technique with little morbidity. Material and methods This is a retrospective single-center study involving a series of 27 patients with an average age of 35 years, including 15 women and 12 men (28 OLTD: 26 medial and 2 lateral), treated between 1997 and 2019 with malleolar osteotomy performed on the side of the lesion and an autograft taken from the homolateral knee. This was a second-line procedure in 9 of the cases. The AOFAS score was primarily used to measure results. Results At final follow-up (mean: 33 months), the mean AOFAS score was 86 (43–100), and the mean FAOS score 80 (10–100). 10 out of 14 patients resumed their sporting activities. These results are in line with similar studies in the literature. Functional results were poorer in cases of active smoking, BMI > 30, previous surgery, late treatment, and especially when the lesion filling was < 80%. The size of the lesion did not seem to influence the outcome, but the context of a work-related accident did. No morbidity was associated with malleolar osteotomy. There were 3 patellar syndromes. Discussion Our study confirms the good medium-term results of the treatment of OLTD by mosaicplasty. Morbidity at the donor site, although it should not be overlooked, is ultimately rarely encountered. Conclusion Mosaicplasty is an integral part of the therapeutic arsenal in the treatment of OLTD. Level of evidence - 4th retrospective study.