Osteochondral Defects of the Talus: Current Management Dilemmas

Osteochondral defects or lesions of the talus represent a management challenge. Arthroscopic débridement is the treatment of choice for patients with an osteochondral lesion of the talus in whom nonsurgical treatment fails. Although surgeons have a better understanding of the risk factors for failed débridement in patients with an osteochondral lesion of the talus, the treatment of patients in whom a high risk for failed débridement exists and patients in whom débridement fails is controversial. Surgeons should understand the current adjunct therapies available for the management of osteochondral lesions of the talus, including cartilage preparations, platelet-rich plasma, bone marrow aspirate, bone graft or bone graft substitutes, and whole bone cartilage transfer (osteochondral autograft transfer); however, evidence for the use of one adjunct therapy more than another is lacking.