Background/Objectives: This prospective study aims to assess the clinical outcomes of the AutoCart™ technique for the treatment of medial osteochondral lesions of the talus (OLT). Methods: 29 consecutive patients treated for medial OLT were included. Demographic characteristics and preoperative imaging (MRI and CT) were reviewed, and patient-reported outcome measures (PROMs)—including a Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the Veterans RAND 12-Item Health Survey (VR-12)—were assessed preoperatively and at 6 and 12 months post-treatment. Results: In the cohort, 14 (48%) were female, 13 (45%) were male, and 2 (7%) did not disclose their gender. Median age was 35.5 years (interquartile range: 23.0–49.5). Mean defect size was 121.95 ± 84.46 mm². Three patients were treated entirely arthroscopically, while 26 patients underwent medial malleolar osteotomy with cancellous bone grafting from the calcaneus for cartilage fragment placement. At one-year follow-up, there were significant improvements in pain and functional outcomes. The VAS score showed a mean reduction of 1.3 points (95% CI: −2.6 to −0.1; p = 0.036). Strong improvement was observed in the FFI, with a mean reduction of 13.3 points (95% CI: −21.0 to −5.6; p = 0.001). The FAAM Sports subscale showed a significant increase of 18.6 points (95% CI: 7.0 to 30.1; p = 0.002). Conclusions: Patients demonstrate clinical improvement after minced cartilage implantation with the AutoCart™ technique. These findings suggest that the minced cartilage procedure is a viable treatment option for medial OLTs, though further studies are needed to assess long-term efficacy.

Background: Osteochondral lesions of the lateral talar shoulder (OLT) represent a significant therapeutic challenge, particularly when associated with chronic lateral ankle instability (CAI). While bone marrow stimulation is well established for talar lesions, clinical evidence on the minced cartilage technique (AutoCart™, Arthrex, Naples, FL, USA) in this specific localization remains limited. This study aimed to evaluate the short-term clinical and functional outcomes following combined treatment of lateral OLT and CAI using autologous minced cartilage and open ligament repair. Methods: Nine patients (mean age: 39.8 years) with symptomatic lateral OLT and concomitant CAI were treated using the minced cartilage technique in conjunction with lateral ligament reconstruction. The mean defect size was 64.8 ± 30.2 mm². Clinical and functional outcomes were assessed at a mean follow-up of 15.8 months using the Foot Function Index (FFI), Visual Analog Scale (VAS) for pain, return-to-sport status, and a motor-cognitive test (Skillcourt system). Postoperative complications and patient satisfaction were recorded. Results: No postoperative complications occurred. All patients reported satisfaction with surgical outcomes. The mean postoperative FFI was 14.92 ± 12.74, indicating minimal functional limitations in daily life. Skillcourt testing revealed no significant side-to-side differences in most tests, except for the Single Leg Stability Test, which showed a significant deficit on the operated side (p = 0.027; Cohen’s d = 0.9). Reduced dorsiflexion limited test performance of four patients. The average postoperative VAS during functional testing was 1.42 ± 1.62. Conclusions: Combined treatment of lateral OLT and CAI using the minced cartilage technique and open ligament stabilization yields favorable short-term clinical and functional outcomes. Despite minor limitations in dorsiflexion, patients achieved high satisfaction rates and functional recovery. These preliminary findings support the technical feasibility and short-term clinical applicability of combining biological cartilage repair with mechanical stabilization for lateral talar lesions < 100 mm². However, larger prospective studies with longer follow-ups are warranted to validate these findings.