Autologous Collagen-Induced Chondrogenesis (ACIC) for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

Background and Objectives: Autologous Collagen-Induced Chondrogenesis (ACIC) is a regenerative technique for treating osteochondral lesions that combines microfracture with the application of an injectable atelocollagen scaffold over the defect. This scaffold stabilizes the marrow clot and promotes the retention of mesenchymal stem cells at the repair site. Its use for Osteochondral Lesions of the Talus (OLTs) has increased in recent years, with several studies reporting favorable clinical outcomes. However, the available evidence has not yet been comprehensively synthesized. The aim of this systematic review and meta-analysis was to evaluate the clinical outcomes of ACIC for the treatment of OLTs. Materials and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating ACIC for the treatment of OLTs were systematically identified and selected. Data regarding patient characteristics, surgical technique, and clinical outcomes were extracted and analyzed. Results: Five studies were included in the systematic review, comprising 97 patients (50 males and 47 females) with a mean age of 40.9 years (range, 25.6–48.6 years). Meta-analysis demonstrated a significant improvement in functional outcomes, with an estimated Mean Difference (MD) in American Orthopaedic Foot & Ankle Society (AOFAS) scores of 26.54 points (95% CI, 17.34–35.74; p < 0.001). Pain outcomes also significantly improved, with a pooled MD in Visual Analogue Scale (VAS) scores of −3.72 points (95% CI, −4.44 to −3.01; p < 0.001). Conclusions: ACIC for OLTs provides consistent improvements in pain and functional outcomes across the available studies. The finding supported by the available data is that postoperative scores improved in small, predominantly uncontrolled cohorts, but the incremental benefit attributable to ACIC over conventional microfracture alone remains uncertain. Therefore, further adequately powered prospective studies directly comparing ACIC with microfracture alone are needed to better establish its clinical efficacy.