Editorial Commentary: Large, Deep, and Cystic Osteochondral Lesions of the Talus May Be Better Treated With Bone Grafting Techniques or Autologous Osteochondral Transplantation Rather Than Bone Marrow Stimulation.

Osteochondral lesions of the talus are a challenging problem to treat. Debridement with bone marrow stimulation has represented the mainstay of treatment for the injuries, with good to excellent results reported. However, some patients do not do well with simple debridement and bone marrow stimulation, which yields a surface of fibrocartilage rather than articular cartilage. Recent studies have focused on prognostic indicators of successful treatment with bone marrow stimulation techniques, including lesion size, ankle stability, lesion location, containment, and the presence of a cyst, among others. The presence of a large bone cyst may be an indication for a more aggressive approach. Cystic lesions may be better suited for bone grafting techniques or articular cartilage replacement procedures (e.g., autologous osteochondral transplantation). Of importance, lesions larger than 90-100 mm sq and deeper than 7.5 mm may be similarly treated.