The diagnosis and management of osteochondral lesions of the talus: osteochondral allograft update

Abstract

m m m b p b e w f he management of osteochondral defects of the talus remains a clinical challenge as a result of the oor intrinsic healing potential of cartilage. Osteohondral lesions of the talus (OLT) is a relatively ommonly cause of ankle pain and disability (Fig 1). artilage has very limited ability for repair or regenration. A biologic solution to the repair of significant artilage defects is the “holy grail.” Some of the bstacles to cartilage repair are the fact that it is highly ascular, hypocellular, and the chondrocytes are “imrisoned” in a matrix (Fig 2). General surgical strategies have consisted of inducng a repair response through microfracture-forming brocartilage. Autologous chondrocyte implantation ACI) has also been used and has some promising esults. We discuss repairing these lesions with an ntact hyaline cartilage organ structure. Osteochondral allografting is a surgical option for steochondral lesions involving the talar dome in paients who have failed non-operative management. llografts are particularly useful for avascular necrois, for larger lesions with more extensive disease, or s a salvage procedure for failed autografting or subhondral perforation. Unlike other surgical strategies hat attempt to stimulate the generation or regeneraion of fibrocartilage through a repair response, the ransplantation of an osteochondral allograft involves lling the defect with viable chondrocytes and an ntact hyaline cartilage organ structure.1-5 The advantages of using allograft are a decrease in atient morbidity, shorter surgical time, smaller inciions, tissue flexibility, and the ability to resurface