Treatment of osteochondral lesions of the talus in athletes: what is the evidence?

Purpose: ankle injuries make up 15% of all sports injuries and osteochondral lesions of the talus (oLts) are an increasingly frequent problem in active patients. There exist no widely shared guidelines on oLt treatment in the athletic population. The aim of this paper is to review all the existing literature evidence on the surgical treatment of oLts in athletes, in order to determine the current state of the art in this specific population, underlining both the limits and the potential of the strategies used. Methods: A systematic review of the literature was performed focusing on the different types of surgical treatment used for oLts in athletes. The screening process and analysis were performed separately by two independent researchers. The inclusion criteria for relevant articles were: clinical reports of any level of evidence, written in English, with no time limitation, or clinical reports describing the treatment of oLts in the athletic population. Results: with the consensus of the two observers, relevant data were then extracted and collected in a single database to be analyzed for the purposes of the present manuscript. At the end of the process, 16 papers met the selection criteria. these papers report a total of 642 athletic patients with oCts. Conclusions: the ideal treatment for cartilage lesions in athletes is a controversial topic, due to the need for an early return to sports, especially in elite players; this need leads to extensive use of microfractures in this population, despite the poor quality of repair associated with this technique. none of the surgical strategies described in this paper seems to be superior to the others. Level of evidence: Systematic review of level IV studies, level IV.