Restoring the talar dome: A comprehensive review of treatment options for osteochondral lesions in adults

Osteochondral lesions of the talus are injuries of the talar dome that are often overlooked until late disease progression. Throughout history, several techniques and treatment modalities have been used in the management of these lesions with an ongoing debate as to which approach is superior to the other, and what the indications and rehabilitation protocols are for each modality. Moreover, the introduction of adjunct therapies such as extracorporeal shockwave therapy and injectables widened the scope of the treatment. While most surgical and nonsurgical approaches have demonstrated satisfactory outcomes, an ideal treatment algorithm is still elusive. This literature review meticulously studies major trends in the different management techniques of osteochondral lesions of the talus, describing the mostly used protocols, comparative results, and complication rates. It also highlights the latest updates on the use of injectables and adjunct therapies, aiming to guide the clinical decision making in treating this pathology.