Arthroscopic Treatment of Osteochondral Lesions of the Talus Using Platelet-Rich Fibrin Biological Scaffold.

BACKGROUND: Osteochondral lesions of the talus (OLT) are a frequent cause of chronic ankle pain and functional limitation. Single-stage biological strategies such as autologous platelet-rich fibrin (PRF) have been proposed as scaffolds to potentially enhance repair. METHODS: This retrospective case series evaluated patients with symptomatic OLT treated arthroscopically with lesion preparation and application of an intraoperatively prepared autologous PRF scaffold (advanced platelet-rich fibrin [A-PRF] and injectable platelet-rich fibrin [i-PRF]), with a minimum clinical follow-up of 8 months (mean 3.8 years). Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) subscales, visual analogue scale (VAS) for pain, return to sports, and complications. RESULTS: Thirty-six patients (14 women, 22 men; mean age 39 years) were included. AOFAS improved from 54.1 to 82.6 (p < 0.001) and VAS pain decreased from 7.58 to 2.69 (p < 0.001) at final follow-up. FAOS domains improved substantially, including quality of life (25.2 to 63.9). More than 80% of patients returned to sports at a mean of 7.6 months. The complication rate was 11%, including transient paresthesia, superficial wound infection, and one reoperation. CONCLUSION: Arthroscopic treatment of OLT augmented with an autologous PRF scaffold was associated with improved pain and function at mid-term follow-up with an acceptable complication profile. Comparative studies are needed to determine the incremental benefit of PRF over marrow stimulation alone.