Managing the cystic osteochondral defect: allograft or autograft

Osteochondral lesions of the talus are generally benign, and many heal or are not symptomatic. A subset of these defects progress to large cystic lesions, which have a less favorable prognosis. The treatment options are joint preservation or sacrifice. Joint salvage entails marrow stimulation techniques or hyaline cartilage replacement with allograft or autograft. When lesions reach greater than 3 cm(2) or Raikin class IV or become uncontained on the shoulders of the talus, autografting techniques become more challenging. Osteochondral allografting may be a better surgical option, often achievable without a malleolar osteotomy for exposure.