title: Operative Treatment for Osteochondral Lesions of the Talus: Biologics and Scaffold-Based Therapy.
abstract: OBJECTIVE
  Numerous basic science articles have published evidence supporting the use of biologic augmentation in the treatment of osteochondral lesions of the talus (OLT). However, a comprehensive evaluation of the clinical outcomes of those treatment modalities in OLT has yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following biologic augmentation to surgical treatments for OLT.
  
  
  METHODS
  A comprehensive literature review was performed. Two commonly used surgical techniques for the treatment of OLT-bone marrow stimulation and osteochondral autograft transfer-are first introduced. The review describes the operative indications, step-by- step operative procedure, clinical outcomes, and concerns associated with each treatment. A review of the currently published basic science and clinical evidence on biologic augmentation in the surgical treatments for OLT, including platelet-rich plasma, concentrated bone marrow aspirate, and scaffold-based therapy follows.
  
  
  RESULTS
  Biologic agents and scaffold-based therapies appear to be promising agents, capable of improving both clinical and radiological outcomes in OLT. Nevertheless, variable production methods of these biologic augmentations confound the interpretation of clinical outcomes of cases treated with these agents.
  
  
  CONCLUSIONS
  Current clinical evidence supports the use of biologic agents in OLT cases. Nonetheless, well-designed clinical trials with patient-specific, validated and objective outcome measurements are warranted to develop standardized clinical guidelines for the use of biologic augmentation for the treatment of OLT in clinical practice.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Adi
authors.initials: A
authors.lastname: Wollstein
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
keywords: autologous osteochondral transplantation; biologic; bone marrow stimulations; concentrated bone marrow aspirate; osteochondral lesions of talus; platelet-rich plasma; scaffold-based therapy