Osteochondral Lesions of the Talus

Osteochondral lesions of the talus (OLT) remain a challenging pathology for the foot and ankle surgery community from diagnosis to treatment. Despite increasing recognition of MRI imaging and other advanced imaging modalities; OLT are often still delayed in diagnosis. The initial treatment of OLT often includes non-operative treatment strategies. When non-operative treatment fails to provide adequate symptom relief or when lesions have characteristics that portend poorer outcomes, surgical intervention may be indicated. A variety of different surgical techniques exist in the treatment of OLT. Arthroscopic bone marrow stimulation remains one of the most common first-line surgical treatments for OLT. Other surgical techniques centered around cartilage replacement with cadaveric cartilage material or cartilage regeneration exist with mixed results. This chapter aims to provide a general overview of the background and treatment of OLT as well as give insight into the senior author’s preferred strategy for the treatment of patients with OLT.