2023 Annual Meeting Foot & Ankle Access Pass-Opinion: Respect and Replace the Subchondral Bone With Osteochondral Solutions for Lesions of the Talus

Opinion: Respect and Replace the Subchondral Bone With Osteochondral Solutions for Lesions of the Talus

Video Transcription

Video Summary

In a debate on osteochondral lesions of the talus, the pros and cons of bone marrow stimulation (BMS) versus osteochondral autograft transplantation (OAT) were discussed. BMS is quick, inexpensive, and effective for small lesions (<10mm, <107mm²), but often results in fibrocartilage and subchondral bone damage, with deterioration over time, especially in larger or cystic lesions. OAT, involving autograft plugs from the knee, offers better mechanical properties and longer-term outcomes, with high return-to-sport rates and low donor site morbidity (<5%). Prior BMS predicts poorer OAT outcomes. Allografts have higher failure rates compared to autografts. Subchondral bone health is critical in treatment choice and success.

Asset Caption

John G. Kennedy, M.D.

Keywords

osteochondral lesions

bone marrow stimulation

osteochondral autograft transplantation

subchondral bone health

return-to-sport rates