Editorial Commentary: Offloading Patellofemoral Chondral Defects Requires Tailored Tibial Tuberosity Osteotomy Procedures.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosures The author declares the following financial interests/personal relationships which may be considered as potential competing interests: M.J.T. has consulting or advisory relationships with Arthrex, Johnson and Johnson, Vericel, and Verywell Health; is a board member of the American Orthopaedic Society for Sports Medicine and the AO Foundation; has received funding grants from Voice in Sport, the Arthroscopic Association of North America, and Fujifilm Corporation; and is an editorial board member of Arthroscopy. 12. Rev Chir Orthop Reparatrice Appar Mot. 2008 Dec;94(8 Suppl):398-408. doi: 10.1016/j.rco.2008.09.003. Epub 2008 Nov 11. Treatment of osteochondral defects of the talus. van Bergen CJ(1), de Leeuw PA, van Dijk CN. Author information: (1)Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD Amsterdam, The Netherlands. c.j.vanbergen@amc.uva.nl This review article provides a current concepts overview of osteochondral defects of the talus, with special emphasis on treatment options, their indications and future developments. Osteochondral defects of the talar dome are mostly caused by a traumatic event. They may lead to deep ankle pain on weight-bearing, prolonged swelling, diminished range of motion and synovitis. Plain radiographs may disclose the lesion. For further diagnostic evaluation, computed tomography (CT) and magnetic resonance imaging (MRI) have demonstrated similar accuracy. Computed tomography is preferred for preoperative planning. Treatment options are diverse and up to the present there is no consensus. Based on the current literature, we present a treatment algorithm that is mainly guided by the size of the lesion. Asymptomatic or low-symptomatic lesions are treated nonoperatively. The primary surgical treatment of defects up to 15 mm in diameter consists of arthroscopic debridement and bone marrow stimulation. For large cystic talar lesions, retrograde drilling combined with a bone graft is an important alternative. In adolescents or in (sub)acute situations, in which the fragment is 15 mm or larger, fixation of the fragment is preferred. Osteochondral autograft transfer and autologous chondrocyte implantation (ACI), with or without a cancellous bone graft, are recommended for secondary cases as well as large lesions. DOI: 10.1016/j.rco.2008.09.003