Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the “gold standard” for lesions <150 mm2, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.

Osteochondral defects of the ankle (OCD) are being increasingly identified as a clinically significant consequence of injury to the ankle, with the potential to lead to osteoarthritis if left untreated. The aim of this retrospective cohort study was to evaluate a single-stage treatment of OCD, based on bone marrow aspirate (BMA) centrifuged to produce bone marrow concentrate (BMC). In a dual syringe, the concentrate was mixed with thrombin in one syringe, whereas hyaluronan and fibrinogen were mixed in a second syringe. The two mixtures were then injected and combined into the prepared defect. Clinical outcome and quality of life scores (MOXFQ and EQ-5D) were collected at baseline and yearly thereafter. Multilevel models were used to analyse the pattern of scores over time. Ninety-four patients were treated between 2015 and 2020. The means of each of the three components of the MOXFQ significantly improved between baseline and 1 year (p < 0.001 for each component), with no further change from year 1 to year 3. The EQ-5D index also improved significantly from baseline to 1 year, with no evidence for further change. Our results strongly indicate that this BMC treatment is safe for, and well tolerated by, patients with OCD of the ankle as both primary treatment and those who have failed primary treatment. This technique provides a safe, efficacious alternative to currently employed cartilage repair techniques, with favourable outcomes and a low complication rate at 36 months.

The fixed-bearing Infinity implant (Wright Medical Group) for total ankle arthroplasty (TAA) was introduced to the U.K. market in 2014 and has rapidly become the most commonly used TAA implant. This is a follow-up report of a multicenter, non-designer, prospective observational study of 503 Infinity fixed-bearing TAA implants. The average follow-up of patients in the current report was 44.9 months (range, 28.3 to 63.9 months). The primary aim was to assess survivorship, complications, and reoperations. Secondary aims were to assess radiographic outcomes and patient-reported outcome measures (PROMs) and the influence of patient factors at 2 years. Four hundred and sixty-nine implants were evaluated at 2-year follow-up. Fifteen patients died, 8 withdrew, and 3 were lost to follow-up. The 2-year survivorship was 98.8%, and the non-revision reoperation rate was 2.8%. There was a significant improvement across all functional outcome scores from baseline to 2 years. The early experience and small rate of adverse events reported in this study continue to support the use of the Infinity TAA implant for the treatment of end-stage ankle arthritis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.