Arthroscopic treatment of osteochondral lesions of the talar dome

Osteochandral lesions of the talus (OLT) may be either traumatic or caused by an osteonecrosis of unknown origin. The different types of OLT differ in their radiological aspects, their treatment and their prog nosis. Whereas traumatic OLTs are generally located on the lateral talar dome, chronic necrotic lesions are preferentially located on the medial talar dome. The farmer have a better prognosis. Arthroscopy is in many cases the treatment of choice. This study presents several arthroscopic treatment options for osteochondral lesions of the talus. Traumatic fragment excision, osteosynthesis of larger fragments on the anterolateral talar dome,and excision and curettage of necrotic lesions may provide good results. In the absence of chondral damage in chronic osteonecrotic lesions, we prefer a transmalleolar drilling. Arthroscopic treatments are relatively simple procedures for trained arthrascopists with a low complication rate. With larger OLTs, open procedures using osteochondral autografts or cancellous bone grafts are preferred to arthroscopy.