Management strategies in the treatment of osteochondral lesions of the talus

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Osteochondral defects of the talus are a common occurrence and remain a challenge to the orthopaedic surgeon. Commonly found on the medial talar dome, they are usually the sequelae from traumatic injuries and often are delayed in their presentation to the outpatient setting. They can occur after ankle trauma, such as sprains or fractures, but they usually present as a continued ankle pain after the initial injury has resolved. Management of these full-thickness cartilage injuries is usually guided by the size, as well as position on the talar dome surface. Arthroscopic microfracture has been the mainstay of first-line surgical treatment as well as for smaller lesions. Larger lesions may need more novel procedures which include scaffold-based therapies or osteochondral transplantation.