Surgical Techniques and Exposures for Osteochondral Lesions of the Talus

Osteochondral lesions in the ankle most commonly occur on the dome of the talus involving the articular surface and the subchondral bone. These lesions are usually seen on the posteromedial or anterolateral aspects of the talar dome. The common presentation is chronic ankle pain with a history of ankle trauma. MRI should be used to further evaluate the ankle in patients suspected of having an osteochondral defect of the talus or if one is seen on plain radiographs of the ankle. Conservative treatment involving a period of casting and non-weight-bearing is recommended for acute, nondisplaced osteochondral lesions. Surgical management is recommended for unstable lesions or failed conservative management. A review of surgical techniques and exposures for treatment of osteochondral lesions of the talus are discussed. The focus is on treatment of osteochondral lesions of the talus. Techniques for debridement, microdrilling, microfracture and osteochondral autograft transfer system (OATS) are described.