Osteochondral Lesion of Talus: Role of Bone Marrow Aspirate Concentrate and Microfracture—What Does the Current Literature Say?

the term "osteochondritis" has been deemed inappropriate by them, with the terms "osteochondrosis" or OCL deemed preferable.5 Kessler et al., 6 in their epidemiological study on OCD of the ankle in children and adolescents, reported an incidence of 4.6 per 1,00,000 in a population around Los Angeles, California, United States.However, the usually reported incidence of OCD of the talus is 0.09% in the published English literature, with the reported prevalence being 0.002 per 1,00,000.2 The prevalence of OCD in developing countries has not been reported yet.The location of the OCD lesion on the talar dome has been classically described as being located in the rims-medial or lateral-, and the central third.7,8 The medial talar rim is reported as the most frequent location of an OCD, with the reported incidence being around 53-55%, while the next most common location is the lateral talar rim with an incidence of 34-42%.An incidence of 25% has been reported for OCD lesions in the central third.Concomitant tibial and talar lesions are present in 35% of cases.9 The softer IntroductIonAs the name suggests, osteochondral lesions (OCL) classically involve a localized region of a joint such that the lesion has both bony and cartilaginous components.These lesions can be seen in almost all synovial joints.Osteochondritis dissecans (OCD) is a subset of OCLs.The frequency of these lesions is higher in weightbearing joints like the ankle joint. 1 One of the hypotheses on the etiology of OCL is of repetitive microtrauma in skeletally immature patients and young adults, leading to a restricted blood supply to a specific region of subchondral bone.In this regard, it is comparable to Perthes disease.If the process of repair gets disrupted for any reason, the lesion progresses further.This results in the subchondral bone developing fissures that tend to involve the overlying articular cartilage as well. 2 What is intriguing is that with further progression, the bone-cartilage region can get separated from the rest of the cartilage and stay attached only through a cartilaginous flap or get completely detached to form a loose body.3 This stepwise progression of the underlying pathology was first detailed by Berndt and Hardy, who provided the classification system that is in use till date.4 The factors responsible for initiation of the OCD lesion and progression of the pathology from stage I to IV have not been fully elucidated.2 The terminology used is not uniform across the published articles, and authors have used various terms for similar lesions.Many terms have been used for this condition, ranging from OCLs, osteochondral fractures (OCF), flake fractures, and trans-talar dome fractures.Terms like traumatic/acute and nontraumatic/ chronic OCD have been used as well.Zanon et al. recommend using the term OCD to describe lesions in children or adolescents that are nontraumatic in nature, and to use osteochondral fractures, often in adults who have had trauma involving both the cartilage and subchondral bone.5 Multiple investigators have reported an absence of inflammatory features in patients with OCD, and hence 1,