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Review
. 2017 Jan 18;8(1):12-20.
doi: 10.5312/wjo.v8.i1.12.

Current management of talar osteochondral lesions

Arianna L Gianakos  1 , Youichi Yasui  1 , Charles P Hannon  1 , John G Kennedy  1
Affiliations
Review

Current management of talar osteochondral lesions

Arianna L Gianakos et al. World J Orthop. .

Abstract

Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.

Keywords: Autologous autograft transfer; Biologics; Bone marrow stimulation; Comprehensive review; Diagnosis; Osteochondral lesions of talus.

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Conflict of interest statement

Conflict-of-interest statement: Kennedy JG is a consultant for Arteriocyte, Inc.; Kennedy JG has received research support from the Ohnell Family Foundation, Mr. and Mrs. Michael J Levitt, and Arteriocyte Inc.; Kennedy JG is a board member for the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Cartilage Repair of the Ankle, American Orthopaedic Foot and Ankle Society Awards and Scholarships Committee, International Cartilage Repair Society finance board.

Figures

Figure 1
Figure 1
Arthroscopic images of osteochondral lesions of the talus. A: Osteochondral lesion of the talus identified arthroscopically; B: Frayed or fibrillated cartilage is curretted out; C: Subchondral plate is violated with microfracture pick; D: After the subchondral bone plate is violated, bleeding occurs beginning the healing response.
Figure 2
Figure 2
Autologous osteochondral transplantation procedure. A: Medial exposure of the talus; B: Preparation of the defect site; C: Insertion of cylindrical osteochondral plug into the prepared osteochondral lesions of the talus defect site; D: Exposure of the medial talus via the chevron-type medial malleolar osteotomy.
See this image and copyright information in PMC

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