Osteochondral Lesions of the Talus: Osteochondral Allograft Transplantation

Talar osteochondral lesions (OCLs) are common causes of ankle pain. When symptomatic, they may cause significant pain and affect function and quality of life. OCLs may be due to acute trauma or atraumatic, repetitive overuse. Lateral lesions are almost always traumatic, secondary to axial loading of the ankle in inversion and dorsiflexion and relative talar external rotation. Medial lesions are frequently caused by loading the ankle with inversion and plantarflexion. Medial lesions are more common than lateral. The extensive coverage of the talar surface area with articular cartilage limits talar vascular supply and creates multiple watershed areas compromising healing potential. As such, early diagnosis and management of talar OCLs are critical to prevent functional impairment and chronic ankle pain. Asymptomatic or incidentally identified talar lesions may be closely observed. Nonoperative management of symptomatic lesions includes rest, ice, oral nonsteroidal anti-inflammatories, immobilization, and intra-articular injections. In patients who fail nonoperative treatment or have an acute displaced osteochondral fragment, surgery is the treatment of choice. Arthroscopic and open surgical approaches are options. Lesion debridement, loose body removal, marrow stimulation techniques (microfracture, drilling, and abrasion), osteochondral autograft, and autologous chondrocyte implantation may result in excellent outcomes in smaller lesions. For larger defects, osteochondral allograft transplantation is the gold standard surgical treatment.