Cartilaginous Non-Structural Allografts in the Management of Foot and Ankle Pathologies

BackgroundCartilaginous non-structural allografts have emerged as biologic adjuncts for the treatment of osteochondral lesions and focal cartilage pathology in the foot and ankle, particularly for lesions that fail bone marrow stimulation (BMS) yet may not warrant osteochondral transplantation. These allografts may serve as an intermediary treatment strategy between BMS and more invasive restorative procedures.MethodsA scoping review of the currently available literature regarding cartilaginous non-structural allografts used in foot and ankle pathology was performed, with a focus on BioCartilage, DeNovo NT, and CartiMax.ResultsBioCartilage may improve radiographic defect fill when used as an adjunct to marrow stimulation procedures, although superior functional outcomes have not been consistently demonstrated. In contrast, DeNovo NT has demonstrated mixed clinical and radiographic outcomes, including persistent postoperative marrow edema, inconsistent graft incorporation, and relatively high complication and failure rates in current studies. Available evidence for BioCartilage and DeNovo NT consists primarily of small clinical studies with heterogeneous methodologies, whereas evidence for CartiMax remains limited to preclinical and industry-supported investigations without published peer-reviewed human clinical outcome studies.ConclusionAlthough these allografts demonstrate potential as biologic adjuncts for cartilage repair, currently available evidence remains limited by heterogeneous study designs, inconsistent outcome reporting, limited comparative data, small cohort sizes, and short-term follow-up. Cost-effectiveness remains an important consideration, given the limited evidence demonstrating long-term functional superiority over traditional marrow stimulation techniques. Further high-quality comparative studies are necessary to determine the long-term efficacy, safety, durability, and cost-effectiveness of cartilaginous non-structural allografts in foot and ankle pathology.Level of Evidence:V: Scoping Review.