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Structural Allograft for Large Osteochondral Lesions of the Talus
Within the foot and the ankle, osteochondral lesions most commonly develop in the talar dome. These osteochondral lesions of the talus (OLTs) represent approximately 4% of all osteochondral lesions and are a well-recognized source of ankle pain and dysfunction. The so-called "massive" OLTs, which are associated with large, communicating subchondral cysts and by definition possess a volume that exceeds 3 cm, are not amenable to standard methods of repair or reconstruction. Until recently, no well-described treatment options successfully addressed these severe defects. Bulk talar allografting is an option that involves anatomically matched talus-to-talus transplantation. Ultimately, talar osteochondral allografts provide a means to transplant mature hyaline cartilage, with viable chondrocytes, into a large defect to recreate a congruent joint. This chapter details the surgical steps for talar osteochondral allograft transplantation of large talar osteochondral lesions.