This critical analysis review from Duke (2017) surveys the full spectrum of surgical treatments for osteochondral lesions of the talus (OLT), asking which technique is appropriate for which lesion. It organizes options into repair (microfracture, retrograde drilling), regeneration (ACI/MACI, bone marrow-derived cells), and replacement (OAT, allograft, PJCAT), and evaluates the evidence supporting each.
When you see an OLT <1.5 cm² without shoulder involvement, microfracture is your starting point — but when the lesion is uncontained, cystic, or has failed prior marrow stimulation, escalate early to regenerative or replacement strategies rather than repeating a procedure with a known high failure rate in that context.
Preoperative CT is essential alongside MRI to quantify osseous/cystic involvement and plan whether bone grafting will be needed.
This critical analysis review from Duke (2017) surveys the full spectrum of surgical treatments for osteochondral lesions of the talus (OLT), asking which technique is appropriate for which lesion. It organizes options into repair (microfracture, retrograde drilling), regeneration (ACI/MACI, bone marrow-derived cells), and replacement (OAT, allograft, PJCAT), and evaluates the evidence supporting each.
When you see an OLT <1.5 cm² without shoulder involvement, microfracture is your starting point — but when the lesion is uncontained, cystic, or has failed prior marrow stimulation, escalate early to regenerative or replacement strategies rather than repeating a procedure with a known high failure rate in that context.
Preoperative CT is essential alongside MRI to quantify osseous/cystic involvement and plan whether bone grafting will be needed.