Current Concepts Review Update: Osteochondral Lesions of the Talus

Nonoperative treatment is initially indicated for patients with early-stage osteochondral lesions of the talus without loose intraarticular fragments, nondisplaced lesions, asymptomatic or minimally symptomatic patients, and those that are improving with physical therapy. Many of these lesions may heal without operative intervention. For patients with higher-grade lesions or those who do not respond to nonoperative management, operative treatment is indicated. For osteochondral lesions of the talus <1.5 cm², microfracture surgery is typically sufficient to provide satisfactory results (Grade B recommendation).¹⁷ Salvage procedures may be performed for patients who do not respond to microfracture or OAT. These may include repeat microfracture,⁷⁵ OAT (Grade B recommendation), osteochondral allograft transplantation (Grade C recommendation), or newer, less invasive procedures such as ACI or MAST.