Operative treatment of osteochondral lesions of the talar dome: Current concepts review

Osteochondral lesions of the talar dome are common problems encountered in orthopaedics. Procedures for the treatment of osteochondral lesions of the talus, including debridement of the joint, shaving of fibrillated cartilage, and resection or perforation of sulachondral bone in the last decade, have been performed arthroscopically with very low morbidity. These seem to be inadequate in lesions larger than 1.5 cm(2) and have not been histologically effective in restoring the hyaline cartilage sheath. Osteochondral allografts or autogenous grafts and autologous chondrocyte transplantation have proven to be capable of restoring the articular hyaline cartilage surface, including defects larger than 2 cm(2), although with higher costs and morbidity. In this review, the aforementioned methods of operative treatment are examined and issues that are related to these methods are discussed.