Surgeons used a small piece of a patient’s own rib cartilage to fill damaged spots in the ankle bone. Two years later, all 28 patients had less pain and better ankle function.
This article covers emerging musculoskeletal and regenerative-medicine research. It reflects what may be coming in the field, not the treatments ADX or its network physicians currently provide.
Why It Matters
The ankle has a thin layer of smooth cartilage that lets the joint glide. A bad sprain, a fall, or a broken ankle can chip that cartilage and the bone underneath it, and the body does not grow it back on its own. One common fix is to cut a plug of healthy cartilage out of the patient’s knee and move it to the ankle – which trades an ankle problem for a knee problem. This study tested a different source: cartilage from the patient’s own rib. Two years later, the repaired ankles were working better and hurting less, and the healthy knee was left alone.
The Study
Osteochondral lesions of the talus (OLT) are injuries to the cartilage cap and the bone just beneath it on the talus, the bone that forms the lower half of the ankle joint. They frequently follow an ankle fracture or a severe sprain, and because adult joint cartilage has almost no blood supply, these defects rarely heal on their own. Existing surgical options each carry a trade-off. Microfracture stimulates the marrow to fill the defect, but the tissue it produces is fibrocartilage rather than the tougher hyaline cartilage the joint started with. Autologous osteochondral transplantation moves a true hyaline cartilage plug into the defect, but the plug is usually harvested from the patient’s knee, creating a new injury in an otherwise healthy joint. There is still no consensus on the best approach.
Researchers led by Dajiang Du tested a third option: autologous costal cartilage transplantation (ACCT), which harvests the graft from the patient’s own rib. Rib cartilage is the body’s largest reservoir of hyaline cartilage, it can be reached without damaging a weight-bearing joint, and it is soft enough to be carved to match the contour of the ankle surface. The team ran a prospective single-arm study at one center, enrolling 28 patients with a medial talar lesion (average age about 42; 19 men, 9 women) and following every one of them for two full years.
Function and pain both improved substantially. The American Orthopaedic Foot and Ankle Society (AOFAS) score, the study’s primary measure, rose from 58.89 before surgery to 86.50 at one year and 90.53 at two years. Pain on a 10-point visual analog scale fell from 3.89 to 0.75, and quality of life on the EQ-5D-5L index climbed from 0.866 to 0.976. Tegner activity scores, a measure of how much sport patients could return to, rose by an average of 1.96 points. Imaging matched the clinical picture: MOCART scores, which grade how well repair tissue fills and integrates into a cartilage defect on MRI, averaged 81.07 at six months and held steady at 82.32 at two years. Every one of the 28 defects was completely filled at two years, and 25 grafts (89.3%) had fully integrated with the surrounding bone. All 28 patients completed follow-up.
The caveats are real and the authors are explicit about them. This was a single-arm study with no comparison group – nobody in the trial received microfracture or a knee-harvested plug, so the results cannot show that ACCT is better than existing techniques, only that it performed well on its own terms. It was run at a single center in 28 patients with medial lesions specifically, it is rated Level IV evidence, and two years is early for a joint-surface repair that needs to last decades. Harvesting rib cartilage also carries its own donor-site considerations. What the study does establish is that rib cartilage can fill and integrate into a talar defect reliably enough to justify the next step, which would be a randomized comparison against the standard techniques and longer follow-up to see whether the repair holds.
Source: JBJS Open Access, Du et al., 2026
Research compiled by ADX AI Agent, reviewed by Sean Gallivan