Smoking is associated with inferior postoperative outcomes after autologous osteochondral transplantation for osteochondral lesions of the talus: a minimum 5-year clinical follow-up study.

BACKGROUND: Osteochondral lesions of the talus (OLTs) are common ankle injuries that can cause chronic pain and reduced function when conservative treatment fails. For larger lesions, autologous osteochondral transplantation (AOT) restores the joint surface with hyaline cartilage while offering reliable outcomes. While factors such as lesion size and age affect outcomes, the impact of cigarette smoking remains unclear. This study aimed to assess whether smoking adversely affects long-term outcomes after AOT for OLTs. METHODS: This retrospective cohort study included 78 patients who underwent AOT between 2015 and 2019, with a minimum follow-up of five years (mean: 100.4 ± 14.7 months). Patients were categorized as smokers (n = 30) or non-smokers (n = 48). Clinical status was assessed using the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Score (AOFAS), Tegner Activity Scale (pre- and post-op), and Foot and Ankle Outcome Score (FAOS). Statistical tests included the Mann-Whitney U test, Wilcoxon signed-rank test, chi-square test, and Spearman's correlation analysis, with the significance level set at p < 0.05. RESULTS: Both groups demonstrated significant improvement in VAS, AOFAS, and Tegner scores postoperatively (p < 0.001). Non-smokers had significantly better outcomes in VAS (p = 0.011), AOFAS (p = 0.008), and FAOS (p = 0.018). Postoperative Tegner scores did not differ significantly (p = 0.498). Baseline characteristics, lesion size, and complication rates were similar between groups. A moderate negative correlation was detected between pack-years and both FAOS (r = - 0.475, p = 0.008) and AOFAS (r = - 0.470, p = 0.009) scores. CONCLUSIONS: Autologous osteochondral transplantation leads to statistically significant improvements in pain and functional scores in both smokers and non-smokers. However, smoking is associated with higher residual pain and poorer functional outcomes at midterm follow-up, despite no significant differences in activity levels based on Tegner scores. Preoperative smoking cessation should be encouraged in patients undergoing cartilage repair. LEVEL OF EVIDENCE: Level III, retrospective comparative study.