Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus—Does Sex Play a Role?

Autologous osteochondral transplantation (AOT) is used in the treatment of osteochondral lesions (OCL) of the talus. The purpose of this study was to compare the differences in the presentation of talar OCLs and outcomes following AOT between male and female patients. Eighty-seven consecutive patients, ages 16 to 65 years, who underwent AOT were retrospectively reviewed. Patients were divided into 2 groups based on sex. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. Fifty-six (64%) males and 31 (36%) females with mean clinical follow-up of 47.2 months were included in this study. OCL defect size was significantly larger in male patients (112.8 mm²) when compared with female patients (88.7 mm²) (p < .001). Male patients presented with a lesion associated with a recognized trauma (p < .006) when compared with female patients who typically presented with associated chronic ankle instability. Mean FAOS improved pre- to postoperatively from 50 to 81 (p < .001) with a statistically significant increase found in male patients (p < .001). The mean MOCART score was 82.1 in male and 86.7 female patients (p < .001). Our study demonstrates potential gender-related differences in the presentation and mechanism of injury in the development of OCLs. It is also not unreasonable to suggest that there may also be differences in treatment and rehabilitation strategies to reduce the risk of developing OCLs in men and women.