Osteochondral lesions of the talus

Osteochondral lesions of the talus are becoming common problems in orthopaedics, with increasingly significant short-term and long-term morbidity, for which early diagnosis is critical. Trauma is the most common cause; however, the role of ischemic necrosis, hereditary contributions and hormonal factors are still unknown. Technological advancements in CT, MRI and arthro-scopy have allowed us to better diagnose and manage this injury. Nonoperative treatment is limited to small, stable lesions (Berndt and Harty stage I-II). Larger lesions (stage III-IV) can be treated effectively by marrow stimulating techniques such as subchondral drilling, especially for older patients. In younger patients with larger lesions, osteochondral autograft procedures (mosaicplasty and osteochondral autograft bone transfer system) and autologous chondrocyte implantation are available and have promising results.