Articular cartilage paste grafting for post-traumatic ankle cartilage lesions: five-patient case series

Introduction Post-traumatic ankle cartilage loss and early osteoarthritis often affect younger, active patients and may progress despite prior procedures, leaving limited joint-preserving options. We report early clinical outcomes of the articular cartilage paste graft technique adapted to the ankle. Case presentation Five patients with symptomatic full-thickness ankle cartilage loss/post-traumatic osteoarthritis involving the talus and/or distal tibia underwent single-stage ankle arthroscopy with debridement and marrow stimulation followed by implantation of autologous osteochondral paste harvested from the intercondylar notch of the knee. Outcomes were assessed at baseline, 6 months, 1 year, and 2 years using VAS pain at rest, during activity, and at night, and 2 supplemental mechanical symptom ratings (0-10): perceived stability and grinding. Mean pain during activity improved from 7.8 ± 1.79 at baseline to 2.4 ± 2.07 at 2 years (Δ 5.4 ± 1.14). Grinding improved from 7.4 ± 2.70 to 1.4 ± 1.67 (Δ 6.0 ± 2.83), and instability improved from 7.4 ± 1.82 to 3.2 ± 2.39 (Δ 4.2 ± 3.27). No patient underwent graft-related revision, arthrodesis, or total ankle arthroplasty. Conclusion The articular cartilage paste graft technique was feasible in the ankle and is associated with sustained improvements in pain and mechanical symptoms, leading to return to high-impact activities for most patients. These results support further evaluation of the paste graft as a viable treatment method that preserves the native joint and encourages full return to activity for patients with post-traumatic ankle cartilage loss.