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Osteochondral lesion of the talus

64 citationsUpdated Sep 2026

Overview

Symptomatic or unstable osteochondral lesions of the talus generally require surgical intervention [1]. While numerous operative techniques exist, most yield similar and satisfactory results [1]. Initial defect size serves as a critical and easily obtainable prognostic factor that may guide preoperative surgical decisions [7]. Treatment selection depends on specific lesion characteristics, including diameter, surface area, depth, and location [16]. Current literature does not support the interchangeability of treatments for primary defects, as different techniques have distinct indications based on lesion size, depth, and cartilage integrity [19]. Future management should aim for primary preventive interventions and an individualised approach focusing on optimal tissue engineering requirements to improve outcomes [23].

Arthroscopic microfracture is a safe and effective procedure for isolated lesions, providing excellent or good clinical outcomes in 89% of patients under 50 years old with lesions of ≤1.5 cm2 at an average follow-up of 33 months [6]. This technique provides similar clinical outcomes for both non-traumatic and traumatic lesions [8] and remains a good long-term option for select patients [5]. Arthroscopic management offers advantages such as better cosmetic results, less pain, and less surgical trauma, though it is technically demanding and should be reserved for experienced foot and ankle arthroscopists [24]. The all-arthroscopic AMIC technique allows precise reconstruction while avoiding the higher morbidity and longer surgical time associated with more invasive operations [12].

For lesions failing initial treatment, various reparative and restorative options are available [16]. Osteochondral autologous transplantation was significantly superior to repeat arthroscopic treatment after a mean follow-up of 48 months [14], and autologous talar graft transplantation can be safely used after failure of primary bone marrow stimulation [15]. Autologous chondrocyte implantation yields enduring long-term results in patients who have failed previous surgery [11], although evidence concerning its use for talar defects remains elusive [25]. Fresh osteochondral autograft transplantation is a reasonable option for young, active patients who have failed non-operative management [52]. The TOPIC procedure is effective for large medial talar dome lesions, resulting in 100% graft consolidation and significant improvement exceeding the minimal clinically important difference in pain scores [36]. A modified mosaicplasty using bony periosteum-covered iliac crest plug transplantation may be recommended for severe and recurrent lesions to restore subchondral bone stock and stable joint function [18].

Anatomy & Pathophysiology

Etiology

The etiology of osteochondral lesions of the talus (OLTs) remains incompletely understood [13, 26]. While the term osteochondritis dissecans may imply an inflammatory disease, this is most likely not the case [13]. Current understanding posits a multifactorial combination of microtraumatic, ischemic, hereditary, and idiopathic factors [13]. Ischemia during endochondral ossification of the epiphyseal cartilage can result in lesion development; epiphyseal cartilage receives nutrients via cartilage canals that normally close upon ossification and maturation [13]. Failure of this closure process, driven by instability of anastomoses between epiphyseal cartilage and mature bone due to poor neoangiogenesis, can lead to avascular necrosis [13]. A stable osteochondral lesion may become symptomatic if the fragment detaches following ankle trauma [13].

Repetitive microtrauma is biomechanically similar to the mechanism of traumatic osteochondral lesions [13]. In this scenario, the damage cascade begins with subchondral stress, which disables the subchondral bone’s ability to intercept ongoing trauma, thereby damaging the overlying cartilage [13]. Forced-dorsiflexion ankle positions can cause such repetitive microtraumas [13]. Genetic factors may also play a role in etiology [13, 26]. Most studies report a history of trauma as the main cause for developing an osteochondral lesion, with lesions especially common after acute and chronic ankle sprains [26]. The impact of multiple forces leads to cartilage contusion, which may transmit to the subchondral bone, causing subchondral microfractures that progress to an osteochondral lesion or subchondral cyst [26]. Metabolic diseases, genetic predisposition, vascular or synovial alterations, or chronic microtraumas are also cited among causes [26]. Trauma is the most common cause of osteochondral lesions of the talar dome, though ischemic necrosis, endocrine disorders, and genetic factors may also have etiologic significance [29].

Anatomy & Location

Medial osteochondral lesions are usually located posteriorly on the dome of the talus, whereas lateral osteochondral lesions are most frequently located anteriorly [29]. The cartilage properties of the various topographic locations within the ankle are significantly different, and opposing articulating surfaces within the ankle exhibit significantly different biomechanical and biochemical properties [59].

Pathophysiology & Pain Mechanisms

Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts [55]. The development of a symptomatic osteochondral defect depends on various factors, including damage and insufficient repair of the subchondral bone plate [55]. The ankle joint has a high congruency [55]. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to localized high increased flow and pressure of fluid in the subchondral bone [55]. This localized high fluid pressure results in local osteolysis and can explain the slow development of a subchondral cyst [55]. Pain from osteochondral defects does not arise from the cartilage lesion but is most probably caused by repetitive high fluid pressure during walking, which stimulates the highly innervated subchondral bone underneath the cartilage defect [55].

The "ankle cartilage cascade" concept proposes that various pathophysiological pathways induce cartilage damage potentially leading to osteoarthritis [97]. Early detection and preventive interventions in the subclinical phase are advocated to stall this cascade [97]. Addressing chronic lateral ankle instability simultaneously with osteochondral lesion treatment may positively impact the long-term health of the ankle joint by protecting repaired cartilage and stopping the cascade of cartilage damage [17].

Natural History & Prognosis

Osteochondral lesions of the talus that successfully underwent an initial nonoperative treatment period had a low failure rate and showed no relevant ankle osteoarthritis progression [2]. Whether an osteochondral lesion of the talus is a precursor to more generalised arthrosis of the ankle remains unclear [51]. In more than one third of cases, conservative treatment of osteochondral lesions is unsuccessful, and surgery is indicated [51]. Smaller osteochondral lesions are symptomatic and, when left untreated, osteochondral lesions can progress [51].

Classification

Radiographic and Arthroscopic Systems

Berndt and Harty: This four-part radiographic system classifies osteochondral lesions of the talus [81]. Stage I is defined as a small subchondral trabecular compression fracture not seen radiographically [81]. Stage II is defined as an incomplete avulsion or separation of the fragment [81]. Stage III is defined as complete avulsion without displacement [81]. Stage IV is defined as a fragment that is detached, rotated, and possibly within the joint [81]. The system may not accurately reflect the integrity of the articular cartilage [29].

Pritsch et al. (1986): This arthroscopic classification grades overlying cartilage as intact, soft, or frayed [43].

Cheng et al. (1995): This arthroscopic classification includes six stages ranging from smooth/intact but soft or ballotable cartilage to a displaced fragment [43].

Other Considerations: There is a lack of correlation between the radiographic appearance of a talar osteochondral lesion and the findings at arthroscopy [65]. MRI may overestimate the stability of an osteochondral lesion of the talus [81].

Magnetic Resonance Imaging (MRI) Classifications

Hepple: This MRI-based classification for osteochondral lesions of the talus regards stages I to IV as mild and stage V as severe [69].

Modified Kramer: This MRI classification is used to assess osteochondral lesions of the talus [85].

Other Considerations: MRI allows for the identification of Stage I lesions in the Berndt and Harty classification [81]. MRI findings in stable osteochondral lesions of the talus include decreased signal intensity on T1-weighted images and either low or increased signal on T2-weighted images [81]. MRI is useful for assessing chondral and subchondral discontinuity indicating lesion instability in Stage II osteochondral lesions [81]. MRI can evaluate the presence of subchondral cysts in osteochondral lesions of the talus [81]. Signal intensity patterns and cyst size on MRI may progress or regress over time and are less reliable indicators of lesion stability than surface continuity [81]. MRI classification of cartilage integrity in pediatric patients with osteochondral lesions of the talus is 95% sensitive and 75% specific for arthroscopic integrity [85]. In patients under 13 years of age, MRI perfectly predicted arthroscopic cartilage integrity for osteochondral lesions of the talus [85].

Computed Tomography (CT) Classifications

CT Arthrography: A new CT arthrographic classification system for osteochondral lesions of the talus has demonstrated excellent inter- and intraobserver agreement [44]. CT with 2-mm cuts in the coronal and axial planes determines whether a lesion is in the anterior, middle, or posterior third of the talar dome [43].

Terminology and Consensus

International Consensus: An international consensus meeting derived terminology guidelines to assist clinicians with the appropriate terminology for osteochondral lesions of the ankle [31].

Clinical Presentation

Etiology and Pathophysiology

The etiology of osteochondral lesions of the talus remains incompletely understood, with leading theories proposing a multifactorial combination of microtraumatic, ischemic, hereditary, and idiopathic factors [13]. Instability of anastomoses between epiphyseal cartilage and mature bone due to poor neoangiogenesis can lead to avascular necrosis and the origin of a stable osteochondral lesion [13]. The etiological theory of repetitive microtrauma is biomechanically similar to the mechanism of an ordinary traumatic osteochondral lesion [13]. In this cascade, subchondral stress presumably disables the subchondral bone to intercept ongoing repetitive trauma, thereby damaging the overlying cartilage [13]. Genetic factors may also play a role in etiology [13]. Most studies report a history of trauma as the main cause for developing an osteochondral lesion of the talus [26], with these lesions being especially common after acute and chronic ankle sprains [26].

Clinical Symptoms and History

Osteochondral lesions of the talar dome are relatively common causes of ankle pain and disability [29]. Patients may report a history of ankle injury, particularly a single or multiple ankle sprains [62]. While osteochondral lesions can be asymptomatic [62], they primarily present as chronic ankle pain, which may decrease after activities [62].

Physical Examination

During outpatient clinic examination, tenderness and swelling of the ankle joint are thoroughly evaluated [62]. The anterior drawer test and forced inversion test are performed during the physical examination to assess stability [62].

Imaging and Diagnosis

Small lesions of the talar dome may be present despite a normal appearance on plain radiography [29]. Bone scintigraphy may show increased radionuclide uptake in the talar dome [29]. Magnetic resonance imaging is sensitive for identifying intraosseous abnormalities in the talus and reveals other types of soft-tissue lesions not visible on routine radiographic studies [29]. Computed tomography remains the imaging technique of choice when delineation of a bone fragment is desired [29]. MRI is commonly applied to confirm the diagnosis, with assessment of the location, size, and grade of the defective area [62]. Computed tomography scans are taken before surgery to help evaluate the size of the osseous lesion [62], while plain radiographs are taken before surgery to help evaluate the progression of osteoarthritis [62].

Anatomical Distribution and Associations

Medial osteochondral lesions of the talar dome are usually located posteriorly on the dome of the talus [29], whereas lateral osteochondral lesions are most frequently located anteriorly [29]. The location of a talar osteochondral lesion correlates with the incidence of a coexisting tibial osteochondral lesion [21]. Osteochondral lesions of the tibial plafond are frequently preceded by ankle trauma and are often associated with coexisting osteochondral lesions of the talus [22]. Osteochondral lesions are frequently seen in patients with ankle fractures when assessed both directly after and at least 12 months after initial trauma, with the vast majority located in the talus [79].

Investigations

Plain radiography: Stress inversion ankle roentgenograms should be considered in cases of talar osteochondritis dissecans to evaluate for lax lateral ligaments [86]. Standard radiographs often fail to determine the specific anterior, middle, or posterior location of talar osteochondral lesions [27].

MRI: Magnetic resonance imaging is indicated when clinical symptoms persist after osteochondral transplantation, though it should not be a routine control [92]. MRI/CT imaging is used to determine if an osteochondral lesion is within the accessible area for medial approaches without medial malleolar osteotomy [66]. MRI analysis indicates that subchondral bones following microfracture for osteochondral lesions of the talus were not restored at midterm follow-up, with a significant decrease in the overall SCBH score over time and deterioration of subchondral cysts [42]. Lesion size measured on MRI does not accurately reflect arthroscopic measurement in talar osteochondral lesions [28].

CT: CT scans in axial and coronal planes are used to locate talar osteochondral lesions, as anterior, middle, or posterior location is often difficult to determine on radiograph [27]. A new CT arthrographic classification system for osteochondral lesions of the talus demonstrated excellent inter- and intraobserver agreement [44]. CT arthrography visualizes tissue growth in osteochondral defects of the talus after microfracture, with tissue growth observed in most cases [20].

Other Considerations: Arthroscopy is a valuable tool for the evaluation and treatment of ankle osteochondral lesions [37].

Treatment

Non-Operative

Nonoperative treatment for osteochondral lesions of the talus is clinically effective in 45% of patients [71]. No evidence was identified that one subtype of non-operative management protocol is superior or inferior to another from a clinical or radiological perspective [71]. Stage-I and Stage-II lesions should be treated non-operatively [56]. Stage-III medial lesions should be treated non-operatively initially but require surgery if symptoms persist [56].

Operative

Indications: Initial defect size may serve as a basis for preoperative surgical decisions for osteochondral lesions of the talus [7]. Stage-III lateral and all Stage-IV lesions should be treated by early operation [56]. A specific indication for arthroscopic drilling is an early lesion with only mild osteosclerosis of the surrounding talar bone, continuity of the cartilaginous surface, and stability of the osteochondral fragment [43]. Patients with symptomatic stage 2 through 4 injuries who were candidates for microfracture techniques had their lesions approached arthroscopically if they were located within the anterior 50% in the anterior-to-posterior direction [64]. When access was limited for central and posterior lesions, open arthrotomy with or without osteotomy was performed [64].

Surgical Approach / Technique: Both arthroscopic subchondral drilling and microfracture are effective and reliable in treating small- to mid-sized osteochondral lesions of the talus [30]. Arthroscopic management of osteochondral lesion of plantar medial talar head is technically demanding and should be reserved for experienced foot and ankle arthroscists [34]. A four-step surgical protocol including synovectomy, debridement, microfractures of the OCL, capsular shrinkage, and bracing and non-weightbearing for 21 days is a safe and clinically effective treatment option in patients with post-traumatic OCLs of the ankle [61]. Surgical treatment consisting of drilling and curettage followed by non-weight-bearing and early range-of-motion exercises yields a good long-term result for transchondral fractures of the talar dome [50]. In a series of 49 patients with surgically treated transchondral fractures of the talar dome, 22 patients had good or excellent results, two had fair results, and one had a poor result [50]. In a series of 49 patients with surgically treated transchondral fractures of the talar dome, no deterioration in functional capacity was noted in 11 patients followed for five to eighteen years [50]. Improvement in the postoperative status for transchondral talar-dome fractures was noted for as long as eighteen months [50]. Arthroscopic drilling for the treatment of medial osteochondral lesions of the talus does not require osteotomy of the medial malleolus or postoperative immobilization [43]. Arthroscopic drilling for medial osteochondral lesions of the talus is less invasive than other types of operative treatment for the condition [43]. Arthroscopic drilling for medial osteochondral lesions of the talus allows early resumption of daily activities and sports [43]. Arthroscopic drilling is reported to be as effective and useful in young patients, especially patients with open physes [43]. Retrograde percutaneous drilling through the sinus tarsi preserves the intact articular cartilage [43]. Bone grafts have been used in conjunction with retrograde drilling to prevent articular collapse due to the difficulty of adequately filling the contours of the lesion [43]. Surgical-grade calcium sulfate in a liquid form has been injected into the defect after drilling [43]. Bone-marrow aspirate harvested from the iliac crest, centrifuged to isolate pluripotent cells, and mixed with calcium graft has been used to promote more rapid healing [43]. CT with 2-mm cuts in the coronal and axial planes determines whether the lesion is in the anterior third, middle third, or posterior third of the talar dome [43]. CT imaging is especially helpful in planning surgery on the medial side, where an osteotomy of the medial malleolus may be necessary [43]. Lateral lesions, even when they are in the middle or posterior third, usually can be approached anteriorly and removed without an osteotomy [43]. An anteromedial approach for posteromedial lesions involves “grooving” the anteromedial distal tibial articular surface 6 to 8 mm to expose the lesion without osteotomy of the medial malleolus [43]. A posteromedial arthrotomy through an anteromedial approach can be used to expose posteromedial lesions of the talus and avoid a medial malleolar osteotomy [43]. A simple approach to the posteromedial ankle through the posterior portion of the posterior tibial tendon sheath allows exposure of the talar dome and the tibial articular surface of the posterior joint and the posterior capsule [43]. The posteromedial approach through the posterior tibial tendon sheath protects the posteromedial tendons, the neurovascular structures, and the deep posterior fibers of the deltoid ligament [43]. If osteotomy of the medial malleolus is necessary, surgery on the medial side should be delayed until after closure of the physis [27]. Four or five holes are made in the subchondral crater with a small drill for vascular ingrowth during excision of an osteochondral fragment of the talus [27]. Medial malleolar osteotomies performed using an inverted Chevron configuration were generally fixed with 2 metallic screws [64]. Patients with stage 5 lesions were treated with autogenous corticocancellous bone graft from their ipsilateral medial malleolus or calcaneus via open arthrotomy [64]. Two cases of stage 5 lesions were treated with autogenous iliac crest bone graft [64]. The degenerated cartilage and fibrous tissue was curetted and excised before placing the corticocancellous bone graft [64]. The corticocancellous bone graft was harvested and then tamped into place, tightly packing the void without leaving any loose fragments of graft prominent [64]. No additional fixation of the graft was needed in all cases treated with autogenous corticocancellous bone graft [64]. The open OATS procedure for medial talar lesions mostly requires a medial malleolar osteotomy to enable better visualization and increase access of the lesion [75].

Implant Selection: Lesions less than 1.5 cm2 are treated with debridement, curettage, microfractures, or retrograde drilling to create fibrocartilage at the affected site [75]. Although procedures for lesions less than 1.5 cm2 have short-term patient satisfaction and good outcomes, unfavorable long-term follow-up with increased pain and decreased function has been reported [75]. To restore hyaline cartilage in recurrent symptoms after marrow stimulation procedures and/or lesions larger than 1.5 cm2, articular cartilage replacement procedures with either OATS or osteochondral allograft have been performed [75]. The advantages of allograft transplantation include restoring the articular surface and eliminating the risk of donor site morbidity [75]. Some authors have discouraged the use of allograft transplantation due to the long duration of recovery and associated complications such as immunogenicity challenges, limited viability of chondrocytes, and cost in low socioeconomic countries [75]. Several authors have favored the use of OATS due to the reported good outcomes regarding pain and functional scores, as well as MRI and arthroscopic evaluation [75]. No reported problems associated with donor site availability and morbidity have been noted for OATS [75].

Other Considerations: Arthroscopic ACI to repair osteochondral lesions in the ankle joint provides satisfactory clinical results after mid-term follow-up [40]. Autologous chondrocyte implantation of the talus yields significant functional improvement [47]. Further investigation is necessary to determine the long-term structural and biomechanical properties of the repair tissue for autologous chondrocyte implantation of the talus [47]. AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport [48]. Numerous treatment strategies for symptomatic osteochondral lesions of the talus have advanced significantly, including reparative, replacement, and regenerative modalities [49]. Future tissue engineering and gene therapy may potentially influence integration and longevity for osteochondral lesions of the talus [49]. Future high-level controlled studies are needed to explore advantages and disadvantages for specific indications in primary osteochondral defects of the talus [19]. Addressing chronic lateral ankle instability simultaneously with osteochondral lesion of the talus treatment may positively impact the long-term health of the ankle joint [17]. Addressing chronic lateral ankle instability simultaneously with osteochondral lesion of the talus treatment may protect repaired cartilage and stop the cascade of cartilage damage [17]. Significantly worse pain and lower functional outcomes are associated with complications if the articular surface of the tibial plafond at the malleolar osteotomy site is incongruent due to failure of reduction [75].

Pain Management: The patient should wear a cast or patellar tendon-bearing brace for 6 to 8 weeks after excision of an osteochondral fragment of the talus [27]. The patient should preferably be non-weight bearing for a total of 8 to 12 weeks after excision of an osteochondral fragment of the talus while fibrocartilaginous tissue in the crater fills in the defect [27]. Patients are immobilized in a walking boot for 6 weeks and then allowed weight bearing in a walking boot until 12 weeks after surgery when osteotomy of the medial malleolus is used to approach a posteromedial lesion [43]. A patellar tendon-bearing brace is sometimes used after surgery to unload the ankle joint [43]. Postoperatively, patients treated with microfracture were kept non-weightbearing for up to 6 weeks [64]. Patients with small lesions (<3 mm in diameter via intraoperative measurement) treated with microfracture were allowed to partially bear weight at 3 weeks [64]. All patients treated with microfracture used a below-knee cast boot for at least 6 weeks [64]. Patients with osteotomies treated with microfracture wore the boot for 10 to 12 weeks depending on healing assessment via radiographic evaluation [64]. Patients were allowed to discontinue use of the cast boot after they were pain-free with ambulation, usually less than 12 weeks [64]. Patients treated with autogenous corticocancellous bone graft were maintained non-weightbearing for 6 weeks in a below-knee cast followed by a cast boot [64].

Complications

Subchondral Bone Changes

Midterm follow-up data indicate that subchondral bone following microfracture for osteochondral lesions of the talus is not restored [42]. Over time, there is a significant decrease in the overall subchondral bone height score [42]. Additionally, subchondral cysts deteriorate over time after microfracture for these lesions [42].

Associated Pathology and Instability

Osteochondral lesions of the tibial plafond are often associated with coexisting osteochondral lesions of the talus [22]. Anterior talofibular ligament injury may lead to osteochondral lesions of the talus [102]. The injured area of the anterior talofibular ligament is an independent influencing factor for the incidence and severity of these lesions [102]. Addressing chronic lateral ankle instability simultaneously with osteochondral lesion of the talus treatment may protect repaired cartilage [17]. This simultaneous management may also stop the cascade of cartilage damage [17].

Recovery

Operative Outcomes: Most reasonable operative techniques for osteochondral lesions of the talus lead to similar and satisfactory results [1]. All analyzed treatment options for osteochondral lesion of the talus were effective with no differences found in terms of score improvements [4]. Arthroscopic microfracture for isolated osteochondral lesions of the talus provides excellent or good clinical outcomes in 89% of patients less than 50 years old with lesions of ≤1.5 cm2 at an average follow-up of 33 months [6]. Microfracture arthroplasty induces repair of localized articular cartilage defects of the talus maintaining the encouraging early results at mid term follow-up [39]. Arthroscopic microfracture treatment provides similar clinical outcomes for non-traumatic and traumatic osteochondral lesions of the talus [8]. Arthroscopic cell-free osteochondral scaffold procedure increases functional and quality of life in localized disease of the ankle joint such as talus osteochondral lesion [10]. Arthroscopic autologous chondrocyte implantation repairs osteochondral lesions in the ankle joint with satisfactory clinical results after mid-term follow-up [40]. The all-arthroscopic AMIC technique allows a very precise reconstruction in the case of cartilage defects and avoids the need for a more invasive operation associated with higher morbidity and a longer surgical time [12]. Osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used [15]. A modified mosaicplasty procedure may lead to restoration of the subchondral bone stock, formation of fibro-cartilage, and stable joint function in severe and recurrent osteochondral lesions of the talus [18]. Treatment of osteochondral defects in the ankle joint with a biomimetic scaffold resulted in incomplete cartilage repair and poor subchondral bone repair at 1- and 2.5-year follow-up [57].

Radiographic and Tissue Findings: After microfracture of osteochondral lesions of the talus, tissue growth in the defects was well visualized using CT arthrography and was observed in most cases [20]. The subchondral bones following microfracture for osteochondral lesions of the talus were not restored at midterm follow-up [42]. There was a significant decrease in the overall SCBH score over time following microfracture for osteochondral lesions of the talus [42]. There was deterioration of subchondral cysts following microfracture for osteochondral lesions of the talus [42].

Other Considerations: Addressing chronic lateral ankle instability simultaneously with osteochondral lesion of the talus treatment may positively impact the long-term health of the ankle joint by protecting repaired cartilage and stopping the cascade of cartilage damage [17].

Key Evidence

  • [L5] Most patients with symptomatic or unstable osteochondral lesions of the talus require surgery, and while many reasonable operative techniques exist, most lead to similar and satisfactory results. [1] (10.1530/eor-22-0024)
  • [L4] Osteochondral lesions of the talus that successfully underwent an initial nonoperative treatment period were associated with minimal symptoms in the long term, a low failure rate, and no relevant ankle osteoarthritis progression. [2] (10.1177/2325967120924183)
  • [L2] Both chondral and osteochondral lesions of the talus treated with arthroscopic microfracture showed similar good clinical outcomes. [3] (10.1007/s00167-014-3061-y)
  • [Paper] All analyzed treatment options were effective for osteochondral lesion of the talus treatment with no differences found in terms of score improvements. [4] (10.1007/s00402-020-03631-z)
  • [L4] Arthroscopic debridement and microfracture provide a good option for the treatment of osteochondral lesions of the talus over the long term in select patients. [5] (10.1007/s00167-016-3990-8)
  • [L4] Arthroscopic microfracture for isolated osteochondral lesions of the talus is a safe and effective procedure that provides excellent or good clinical outcomes in 89% of patients of less than 50 years old with lesions of ≤1.5 cm2 at an average follow-up of 33 months. [6] (10.1007/s00167-009-0914-x)
  • [L3] Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and may serve as a basis for preoperative surgical decisions. [7] (10.1177/0363546509335765)
  • [L3] Arthroscopic microfracture treatment provides similar clinical outcomes in the case of non-traumatic and traumatic osteochondral lesions of the talus. [8] (10.1186/s12891-025-08949-6)
  • [L5] Arthroscopic management of osteochondral lesions of the talus is well documented with favorable results for reparative techniques. [9] (10.5435/00124635-200907000-00001)
  • [L4] Arthroscopic cell-free osteochondral scaffold procedure appears to be an effective treatment with increasing the functional and quality of life, particularly in localized disease of the ankle joint such as talus osteochondral lesion. [10] (10.1177/2325967114s00160)
  • [L4] Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for osteochondral lesions of the talus. [11] (10.1177/0363546514540587)
  • [Paper] The all-arthroscopic AMIC technique for the treatment of osteochondral lesions of the talus allows a very precise reconstruction in the case of cartilage defects and avoids the need for a more invasive operation associated with higher morbidity and a longer surgical time. [12] (10.1016/j.eats.2015.02.010)
  • [Case_report] [13] (10.1016/j.jisako.2023.05.002)
  • [L3] Osteochondral autologous transplantation was significantly superior to repeat arthroscopic treatment of osteochondral lesions of the talus after a mean follow-up period of 48 months. [14] (10.1177/0363546514535186)
  • [L4] The midterm results suggest that the technique of osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used. [15] (10.1007/s00167-014-3389-3)
  • [L5] Treatment selection for osteochondral lesions of the talus depends on lesion characteristics such as diameter, surface area, depth, and location, with various reparative and restorative surgical options available. [16] (10.1016/j.arthro.2021.10.002)
  • [L5] Addressing chronic lateral ankle instability simultaneously with osteochondral lesion of the talus treatment may positively impact the long-term health of the ankle joint by protecting repaired cartilage and stopping the cascade of cartilage damage. [17] (10.1016/j.arthro.2025.02.005)
  • [L4] This modified mosaicplasty might be recommended for severe and recurrent osteochondral lesions of the talus and may lead to restoration of the subchondral bone stock, formation of fibro-cartilage, and stable joint function. [18] (10.1007/s00167-013-2604-y)
  • [Letter] Current literature does not support the interchangeability of treatments for primary osteochondral defects of the talus, as different techniques have different indications based on lesion size, depth, and cartilage integrity; future high-level controlled studies are needed to explore advantages and disadvantages for specific indications. [19] (10.1007/s00167-017-4700-x)
  • [L4] After microfracture of osteochondral lesions of the talus, tissue growth in the defects was well visualized using CT arthrography and was observed in most cases. [20] (10.1007/s00167-017-4610-y)
  • [L4] The location of a talar osteochondral lesion correlates with the incidence of a coexisting tibial osteochondral lesion. [21] (10.1177/2325967118790965)
  • [L4] OLTPs are frequently preceded by ankle trauma and are often associated with coexisting osteochondral lesions of the talus. [22] (10.1177/23259671211029208)
  • [L5] Future management should aim for primary preventive interventions and an individualised approach focusing on optimal tissue engineering requirements to improve outcomes for osteochondral lesions of the talus. [23] (10.1007/s00167-019-05647-4)
  • [Paper] Arthroscopic management of osteochondral lesions of the talar head offers advantages of better cosmetic results, less pain, and less surgical trauma, though the technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists. [24] (10.1016/j.eats.2019.05.006)
  • [L1] Evidence concerning the use of ACI for osteochondral and chondral defects of the talus is still elusive. [25] (10.1007/s00167-011-1729-0)
  • [L5] [26] (10.1136/jisakos-2016-000099)
  • [L5] [29] (10.5435/00124635-199603000-00001)
  • [L3] The results of this study suggest that both techniques are effective and reliable in treating small- to mid-sized osteochondral lesions of the talus, regardless of which of the two techniques is used. [30] (10.1007/s00167-015-3511-1)
  • [L5] This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle. [31] (10.1016/j.jisako.2021.12.001)
  • [Paper] This technique is technically demanding and should be reserved for experienced foot and ankle arthroscists. [34] (10.1016/j.eats.2018.09.001)
  • [L4] The TOPIC procedure for large osteochondral lesions of the medial talar dome is an effective technique that resulted in significant improvement exceeding the minimal clinically important difference in pain scores as well as in other outcomes, with 100% consolidation of the grafts. [36] (10.2106/jbjs.22.01322)
  • [L4] Arthroscopy is a valuable tool for evaluation and treatment of ankle osteochondral lesions. [37] (10.1016/j.arthro.2007.03.086)
  • [L3] Microfracture arthroplasty induces repair of localized articular cartilage defects of the talus maintaining the encouraging early results at mid term follow-up. [39] (10.1007/s00167-009-1036-1)
  • [L4] This study confirmed the ability of arthroscopic ACI to repair osteochondral lesions in the ankle joint with satisfactory clinical results after mid-term follow-up. [40] (10.1007/s00167-013-2640-7)
  • [L4] The subchondral bones following microfracture for osteochondral lesions of the talus were not restored at midterm follow-up, with a significant decrease in the overall SCBH score over time and deterioration of subchondral cysts. [42] (10.1177/0363546517739606)
  • [L1] The study showed an excellent inter- and intraobserver agreement for the new CT arthrographic classification system of osteochondral lesions of the talus. [44] (10.1016/j.otsr.2021.102890)
  • [L4] Autologous chondrocyte implantation of the talus yields significant functional improvement; however, further investigation is necessary to determine the long-term structural and biomechanical properties of the repair tissue. [47] (10.1177/0363546508325670)
  • [L4] AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. [48] (10.1177/0363546519841574)
  • [L5] Numerous treatment strategies for symptomatic osteochondral lesions of the talus have advanced significantly, including reparative, replacement, and regenerative modalities, with future tissue engineering and gene therapy potentially influencing integration and longevity. [49] (10.1177/2325967119s00453)
  • [L4] [50] (10.2106/00004623-198062040-00020)
  • [Paper] [51] (10.1007/s00264-013-2076-1)
  • [L4] Fresh OCA transplantation is a reasonable surgical option for osteochondral defects of the talus for young, active patients who have failed non‐operative management. [52] (10.1177/2325967123s00093)
  • [L5] [55] (10.1007/s00167-010-1064-x)
  • [L4] Stage-I and Stage-II lesions should be treated non-operatively; Stage-III medial lesions should be treated non-operatively initially but require surgery if symptoms persist; Stage-III lateral and all Stage-IV lesions should be treated by early operation. [56] (10.2106/jbjs.l.00773)
  • [L4] Treatment of osteochondral defects in the ankle and knee joint with a biomimetic scaffold resulted in incomplete cartilage repair and poor subchondral bone repair at 1- and 2.5-year follow-up. [57] (10.1007/s00167-015-3538-3)
  • [Paper] The cartilage properties of the various topographic locations within the ankle are significantly different, with opposing articulating surfaces exhibiting significantly different biomechanical and biochemical properties. [59] (10.1016/j.arthro.2014.05.025)
  • [L4] [61] (10.1007/s00167-012-2028-0)
  • [L5] [62] (10.1016/j.eats.2024.103208)
  • [L4] [64] (10.1177/0363546507303561)
  • [L4] [65] (10.2106/00004623-198668060-00007)
  • [L5] If the osteochondral lesion is within the accessible area through either approach as viewed on MRI/CT, it can be safely reached without a medial malleolar osteotomy. [66] (10.1007/s00167-009-1019-2)
  • [L3] [69] (10.1186/s13018-025-06232-x)
  • [L4] [71] (10.1007/s00167-023-07408-w)
  • [L4] [75] (10.1016/j.eats.2024.103109)
  • [L4] OCLs are frequently seen in patients with ankle fractures when assessed both directly after and at least 12 months after initial trauma (45–47%, respectively), with the vast majority located in the talus. [79] (10.1007/s00167-020-06187-y)
  • [L3] [85] (10.1177/2325967121s00219)
  • [L4] The case demonstrates that repeated inversion stress in ankles with lax lateral ligaments can result in osteochondral lesions of the medial part of the talus, and stress inversion ankle roentgenograms should be considered in cases of talar osteochondritis dissecans. [86] (10.2106/00004623-197052010-00018)
  • [L4] Magnetic resonance imaging should not be a routine control but appears to be indicated when clinical symptoms persist after osteochondral transplantation. [92] (10.1177/0363546510397726)
  • [L5] The paper proposes the 'ankle cartilage cascade' concept where various pathophysiological pathways induce cartilage damage potentially leading to osteoarthritis, and advocates for early detection and preventive interventions in the subclinical phase to stall this cascade. [97] (10.1007/s00167-021-06755-w)
  • [L3] Anterior talofibular ligament injury may lead to osteochondral lesions of the talus, with injured area identified as an independent influencing factor for the incidence and severity of OLT. [102] (10.1186/s13018-024-04826-5)

See Also

References

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[3] Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3061-y

[4] One-year follow-up data from the German Cartilage Registry (KnorpelRegister DGOU) in the treatment of chondral and osteochondral defects of the talus. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03631-z

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[9] Cartilage Transplantation Techniques for Talar Cartilage Lesions. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200907000-00001

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[12] All‐Arthroscopic Autologous Matrix‐Induced Chondrogenesis for the Treatment of Osteochondral Lesions of the Talus. Arthroscopy Techniques. 2015. DOI: 10.1016/j.eats.2015.02.010

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[18] Bony periosteum‐covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2604-y

[19] Comment on “No superior treatment for primary osteochondral defects of the talus. Dahmen J, et al. KSSTA 2017 Jun 27 PMID:28656457”. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4700-x

[20] CT arthrography visualizes tissue growth of osteochondral defects of the talus after microfracture. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4610-y

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