Osteochondral lesions of the talus: current opinions on diagnosis and management

Purpose of review: This review examines the current literature on osteochondral lesions of the talus. We report on some of the interesting studies relating to the knee to try to determine current trends and opinions. Recent findings: Exciting studies have been published over the last year with longer follow-up and larger sample sizes than previous studies. Reports on osteochondral autografting and autologous chondrocyte implantation have shown good outcomes and durability. Direct comparison studies between marrow stimulation (microfracture and arthroscopic drilling) and cartilage repair techniques showed good results in both groups of patients. Summary: The lack of long-term prospective controlled randomized studies makes it difficult to interpret the current literature, but marrow stimulation techniques offer the clinician a reasonable first-line treatment for osteochondral lesions of the talus. While these techniques result in biomechanically inferior fibrocartilage formation, studies have shown an improvement in clinical scores and radiographic markers without eliminating the future possibility of subsequent mosaicplasty or autologous chondrocyte implantation. The treating orthopaedic surgeon needs to be familiar with multiple techniques to most effectively treat patients with these difficult problems.