Abstract：Objective To summarize operative treatment of osteochondral lesions of the talus.Methods A computer-based search was conducted in PubMed and Springer link for literatures related to operative treatment of osteochondral lesions of the talus from January 2010 to November 2014 with the key words "osteochondral lesions", "talus" in English. Analysis was conducted based on the articles.Results Surgical options are lesion excision, excision and curettage, microfracturing, antegrade (transmalleolar) drilling, retrograde drilling, which are suitable for younger patients with small, superficial or isolated lesions, fixation and techniques such as osteochondral transplantation(autograft or allograft) and autologous chondrocyte implantation. Osteochondral transplantation is often applied if the damages are large or osteochondral lesions. The arthroscopic technique with the superiority of minimally invasive, orthophoria operation may represent a precious aid for the orthopedic surgeon and for the patient′s outcome. Diagnosis and treatment can be conducted simultaneously with arthroscopic technique. It is the first choice of the operative treatment of osteochondral lesions of the talus. In children, the lesions are rare. Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment.Conclusions In most cases, several treatment options are viable, which have their indications and the advantages and disadvantages. The principle of "individualization" should be emphasized and the choice of treatment is based on defect type and size, age of patients and preferences of the treating clinician. It is the key to surgical treatment.
王双利, 潘政军, 江华, 黄彰. 距骨骨软骨损伤手术治疗的研究进展[J]. 中华解剖与临床杂志, 2016, 21(2): 172-175.
Wang Shuangli, Pan Zhengjun, Jiang Hua, Huang Zhang.. Research progress on operative treatment of osteochondral lesions of the talus. Chinese Journal of Anatomy and Clinics, 2016, 21(2): 172-175.
Bruns J, Sobottka I, Delling G, et al. Has osteochondritis an infectious aetiology?[J]. Eur Orthop Traumatol, 2012, 3(1): 61-65. DOI:10.1007/s12570-012-0093-y
[2]
van Dijk CN, Reilingh ML, Zengerink M, et al. Osteochondral defects in the ankle: why painful?[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 570-580. DOI:10.1007/s00167-010-1064-x
[3]
Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle[J]. Int Orthop, 2013, 37(9): 1697-1706. DOI:10.1007/s00264-013-2076-1
[4]
Kuni B, Schmitt H, Chloridis D, et al. Clinical and MRI results after microfracture of osteochondral lesions of the talus[J]. Arch Orthop Trauma Surg, 2012, 132(12): 1765-1771. DOI:10.1007/s00402-012-1595-3
[5]
Becher C, Zühlke D, Plaas C, et al. T2-mapping at 3 T after microfracture in the treatment of osteochondral defects of the talus at an average follow-up of 8 years[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8): 2406-2412. DOI:10.1007/s00167-014-2913-9
[6]
Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663. DOI:10.1007/s00167-009-1036-1
[7]
Lee KB, Bai LB, Chung JY, et al. Arthroscopic microfracture for osteochondral lesions of the talus[J]. Knee Surgery Sports Traumatology Arthroscopy, 2010, 18(2): 247-253. DOI:10.1007/s00167-009-0914-x
[8]
Park HW, Lee KB. Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(3): 860-867. DOI:10.1007/s00167-014-3061-y
[9]
Angthong C, Yoshimura I, Kanazawa K, et al. Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(6): 1418-1426. DOI:10.1007/s00167-013-2364-8
[10]
Kok AC, Tuijthof GJ, Den Dunnen S, et al. No effect of hole geometry in microfracture for talar osteochondral defects[J]. Clin Orthop Relat Res, 2013, 471(11): 3653-3662. DOI:10.1007/s11999-013-3189-y
[11]
Anders S, Lechler P, Rackl W, et al. Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus[J]. Int Orthop, 2012, 36(8): 1635-1640. DOI:10.1007/s00264-012-1530-9
[12]
Gras F, Marintschev I, Kahler DM, et al. Fluoro-Free navigated retrograde drilling of osteochondral lesions[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(1): 55-59. DOI:10.1007/s00167-010-1260-8
[13]
Petersen W, Taheri P, Schliemann B, et al. Osteochondral transplantation for the treatment of osteochondral defects at the talus with the Diamond twin system® and graft harvesting from the posterior femoral condyles[J]. Arch Orthop Trauma Surg, 2014, 134(6): 843-852. DOI:10.1007/s00402-014-1991-y
[14]
Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1925-1930. DOI:10.1007/s00167-013-2483-2
[15]
Leumann A, Valderrabano V, Wiewiorski M, et al. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(6): 1304-1310. DOI:10.1007/s00167-013-2604-y
[16]
Anders S, Goetz J, Schubert T, et al. Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation-results at five years[J]. Int Orthop, 2012, 36(11): 2279-2285. DOI:10.1007/s00264-012-1635-1
[17]
Lee KT, Kim JS, Young KW, et al. The use of fibrin matrix-mixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(6): 1251-1260. DOI:10.1007/s00167-012-2096-1
[18]
Volpi P, Bait C, Quaglia A, et al. Autologous collagen-induced chondrogenesis technique (ACIC) for the treatment of chondral lesions of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(6): 1320-1326. DOI:10.1007/s00167-013-2830-3
[19]
Battaglia M, Vannini F, Buda R, et al. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: mid-term T2-mapping MRI evaluation[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(8): 1376-1384. DOI:10.1007/s00167-011-1509-x
[20]
Niemeyer P, Salzmann G, Schmal H, et al. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(9): 1696-1703. DOI:10.1007/s00167-011-1729-0
[21]
Cavallo M, Natali S, Ruffilli A, et al. Ankle surgery: focus on arthroscopy[J]. Musculoskelet Surg, 2013, 97(3): 237-245. DOI:10.1007/s12306-013-0297-5
[22]
Kim HN, Park YJ, Kim GL, et al. Arthroscopy combined with hardware removal for chronic pain after ankle fracture[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(6): 1427-1433. DOI:10.1007/s00167-012-2298-6
[23]
Jung HG, Carag JA, Park JY, et al. Role of arthroscopic microfracture for cystic type osteochondral lesions of the talus with radiographic enhanced MRI support[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(5): 858-862. DOI:10.1007/s00167-011-1411-6
[24]
Guney A, Akar M, Karaman I, et al. Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8): 2384-2389. DOI:10.1007/s00167-013-2784-5
[25]
Doral MN, Bilge O, Batmaz G, et al. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(7): 1398-1403. DOI:10.1007/s00167-011-1856-7
[26]
van Bergen CJ, Reilingh ML, van Dijk CN. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 999-1003. DOI:10.1007/s00167-011-1465-5
[27]
Reilingh ML, Kerkhoffs GM, Telkamp CJ, et al. Treatment of osteochondral defects of the talus in children[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(9): 2243-2249. DOI:10.1007/s00167-013-2685-7
[28]
Martinelli N, Bonifacini C, Romeo G, et al. Treatment of osteochondral defects of the talus in children[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4): 1265. DOI:10.1007/s00167-014-3125-z
2016, Vol. 21 
