Patient-specific talar resurfacing improves pain and function at 24 months in osteochondral lesions of the talus

Osteochondral lesions of the talus are a frequent cause of ankle pain and functional limitation, particularly in physically active patients. The purpose of this prospective study was to assess patient-reported outcomes, return to sport and work and safety after second-generation patient-specific focal talar resurfacing in patients with symptomatic talar osteochondral lesions. Between October 2021 and July 2023, 40 patients were screened and 20 underwent implantation of a customized focal talar resurfacing implant. Outcomes were collected preoperatively and at 3, 6, 12 and 24 months using the Foot and Ankle Outcome Score (FAOS), visual analogue scale pain at rest and during activity and the EuroQol 5-dimension 5-level questionnaire. Time to return to sport and work and adverse events (complications, reoperations and treatment failures) were recorded. Changes over time were assessed with repeated-measures analysis of variance. Best-case and worst-case sensitivity analyses explored the impact of incomplete 24-month follow-up on treatment-failure estimates. Seventeen patients completed the 24-month follow-up. The mean FAOS total increased from 58.6 ± 16.6 preoperatively to 97.3 ± 4.9 at 24 months. Pain improved from 4.3 ± 2.7 to 0.0 ± 0.0 at rest and from 6.8 ± 1.7 to 0.1 ± 0.3 during activity. Seventeen of 20 patients returned to sport at a mean of 5.1 ± 3.2 months, and mean time to return to work was 4.2 ± 3.0 months. Three complications occurred, including one treatment failure requiring revision surgery. The observed treatment-failure rate was 1/20 (5%). Patient-specific talar resurfacing was associated with sustained improvements in pain, function and quality of life at 24 months, with high rates of return to sport and work. Larger studies with longer follow-up are needed to confirm durability and refine patient selection. Level II.