Cartilage repair of the talus.
The cause of a typical osteochondral lesion of the talus is traumatic; if symptomatic, several options exist. Because nonoperative treatment results in no more than 50% good to excellent results, the following types of surgery are in clinical use: (1) debridement and drilling, (2) osteochondral transfer, and (3) autologous chondrocyte transplantation. Reported good to excellent results are at least 80% in the short term. Currently available data allow no recommendation of a specific therapy for a specific lesion. Advocates of drilling and debridement accept that the repair tissue is fibrocartilage; osteochondral transfer includes a donor side morbidity. We are still at the beginning of cartilage repair; it will take time before a certain type of lesion can be treated with the best modality because that requires comparative randomized prospective studies with a long follow-up. All modern cartilage repair techniques, that were initially investigated at the knee joint, are now in use for ankle osteochondral lesions. Reported short-term success rates are greater than 80%. Further improvements will depend on the understanding of the pathogenesis and the role of contributing factors (eg, instability).
Schäfer
Dirk B
DB
Orthopaedic Clinic of the University of Basel, Spitalstr. 21, CH-4031 Basel, Switzerland. dschaefer@uhbs.ch
D000843:Ankle Joint / Q000601:surgery; D002357:Cartilage Diseases / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D002358:Cartilage, Articular / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation; D006801:Humans; D013628:Talus / Q000601:surgery*