Current concept review: osteochondral lesions of the talus.

Sacramento, CA, USA.
Foot & Ankle International (Impact Factor: 1.63). 01/2010; 31(1):90-101. DOI: 10.3113/FAI.2010.0090
Source: PubMed
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    ABSTRACT: Several options exist for the treatment of osteochondral lesions of the talus. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment modality for osteochondral lesions of the talus that are not amenable to microfracture or for which microfracture has failed. Arthroscopic placement of this type of graft obviates the need for osteotomy or plafondplasty and does not prevent additional procedures from being performed through an anterior approach. Special instrumentation and setup are not required to perform this procedure. Our arthroscopic technique for placement of particulated juvenile cartilage into osteochondral lesions of the talus is described. Case series and outcomes after arthroscopic ankle PJCAT are currently not reported within the literature; however, it is believed that the outcomes are at least similar to those of open ankle PJCAT.
    08/2014; 3(4). DOI:10.1016/j.eats.2014.06.004
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    ABSTRACT: Osteochondral lesions of the talus are being recognized as an increasingly common injury. They are most commonly located postero-medially or antero-laterally, while centrally located lesions are uncommon. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation (or similar methods) or osteochondral allograft transplantation. Allograft procedures have become popular due to inherent advantages over other resurfacing techniques. Cartilage viability is one of the most important factors for successful clinical outcomes after transplantation of osteochondral allografts and is related to storage length and intra-operative factors. While there is abundant literature about osteochondral allograft transplantation in the knee, there are few papers about this procedure in the talus. Failure of non-operative management, initial debridement, curettage or microfractures are an indication for resurfacing. Patients should have a functional ankle motion, closed growth plates, absence of cartilage lesions on the tibial side. This paper reviews the published literature about osteochondral allograft transplantation of the talus focusing on indications, pre-operative planning, surgical approaches, postoperative management, results and complications of this procedure.
    The Iowa orthopaedic journal 01/2014; 34:30-7.
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    ABSTRACT: Osteochondral defects (OCDs) of the talus are an increasingly recognized common injury, and may occur in up to 50% of acute ankle sprains and fractures. There is a consensus regarding non-operative management of asymptomatic OCDs of the talus. Surgery is often indicated in symptomatic cases and multiple techniques have been proposed, each with specific advantages and disadvantages. Acute OCDs are usually treated by excision particularly if the fragment is small, displaced, or comminuted. If the fragment is large with a cartilage surface intact, repair may be attempted, particularly with an antero-lateral location. In chronic lesions, most authors consider non-operative management as the standard first-line approach for non-displaced lesions. Initial surgical treatment usually consists of debridement, curettage or microfracture to obtain a stable bleeding base. Failed initial debridement is an indication for resurfacing, with osteo articular cartilage transfer or mosaicplasty, autologous chondrocyte implantation, or similar techniques utilizing cartilage fragments or scaffolds performed as initial options. Generally, osteochondral allograft transplantation is considered as a salvage procedure, or for large lesions with significant bone loss that cannot be treated successfully with other resurfacing techniques.
    Operative Techniques in Sports Medicine 12/2014; 22(4). DOI:10.1053/j.otsm.2014.09.006 · 0.21 Impact Factor