Cartilage repair techniques of the talus: An update

Abstract

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

Good clinical outcome after osteochondral autologous transplantation surgery for osteochondral lesions of the talus but at the cost of a high rate of complications: a systematic review

“…In about 24% of cases, non-traumatic causes are reported 3. Causes of non-traumatic OLT may be vascular, genetic, morphological, endocrine or idiopathic 4 5…”

“…It is stated that asymptomatic lesions should not be treated, but kept under observation 5. In case of mild symptoms and in early phases of OLT, conservative treatment is advised 9–11.…”

Juvenile Particulate Osteochondral Allograft for Treatment of Osteochondral Lesions of the Talus: Detection of Altered Repair Tissue Biochemical Composition Using 7 Tesla MRI and T2 Mapping

“…To relieve symptoms, restore mobility, and prevent long-term arthritic sequelae, various operative treatment options have been developed, including microfracture/drilling, autologous osteochondral transplantation, osteochondral allograft transplantation, and autologous chondrocyte transplantation. No technique appears to be superior to the others (6), and each option has associated strengths and weaknesses (6). Currently, surgeon preference has a significant role in decision making.…”

Arthroscopic debridement and bone marrow stimulation for talar osteochondral lesions: current concepts

“…These injuries are especially common after acute and chronic ankle sprains 7–9. The impact of multiple forces leads to a cartilage contusion, which may be transmitted to the subchondral bone, causing subchondral microfractures progressing to an OCD or subchondral cyst 6. Metabolic diseases, genetic predisposition, vascular or synovial alterations or chronic microtraumas are also cited among the causes of OCDs development 10–13…”