Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2017; 8(1): 12-20
Published online Jan 18, 2017. doi: 10.5312/wjo.v8.i1.12
Current management of talar osteochondral lesions
Arianna L Gianakos, Youichi Yasui, Charles P Hannon, John G Kennedy
Arianna L Gianakos, Department of Orthopedic Surgery, 2nd Jersey City Medical Center, Jersey City, NJ 07302, United States
Arianna L Gianakos, Youichi Yasui, Charles P Hannon, John G Kennedy, Department of Foot and Ankle, Hospital for Special Surgery, New York, NY 10021, United States
Youichi Yasui, Department of Orthopaedic Surgery, 2nd Teikyo University School of Medicine, Tokyo 173-8606, Japan
Charles P Hannon, 2nd Department of Orthopaedic Surgery, Rush University Medical Center (C.P.H.), Chicago, IL 60612, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: John G Kennedy, MD, MCh, MMSc, FRCS (Orth), Department of Foot and Ankle, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY 10021, United States.
Telephone: +1-646-7978880 Fax: +1-646-797896
Received: June 16, 2016
Peer-review started: June 17, 2016
First decision: July 27, 2016
Revised: September 12, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: January 18, 2017

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: Osteochondral lesions of talus, Comprehensive review, Diagnosis, Bone marrow stimulation, Autologous autograft transfer, Biologics

Core tip: Osteochondral lesions of the talus are often missed after acute ankle sprains and fractures. Magnetic resonance imaging is most sensitive in diagnosing these injuries. Bone marrow stimulation (BMS) is effective for lesions < 150 mm2 in area, but replacement procedures such as autologous osteochondral transplantation or allografts may be required for larger lesions or if BMS fails. Long term studies should attempt to determine the most effective treatment strategy and the critical defect strategy beyond which BMS will not work.