Objective: To provide a comprehensive overview of the surgical treatments of osteochondral lesion of talus (OLT) and offer valuable insights for clinical practice.
Methods: The advantages and limitations of surgical treatments for OLT were comprehensively summarized through an extensive review of domestic and abroad relevant literature in recent years.
Results: Currently, there exist numerous surgical treatments for the OLT, all of which can yield favorable outcomes. However, each method possesses its own set of merits and demerits. The short-term effectiveness of bone marrow stimulation in treating primary OLT with a diameter less than 15 mm is evident, but its long-term effectiveness diminishes over time. Autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT) are suitable for OLT with large defects and subchondral bone cysts. However, incomplete anatomical matching between the donor and recipient bones may results in the formation of new subchondral bone cysts, while AOT also presents potential complications at the donor site. In contrast to AOT and OAT, particulated juvenile cartilage allograft transplantation obviates the need for additional osteotomy. Furthermore, juvenile cartilage exhibits enhanced potential in delivering active chondrocytes to the site of cartilage defect, surpassing that of adult cartilage in tissue repair efficacy. Cell transplantation has demonstrated satisfactory effectiveness; however, it is associated with challenges such as the requirement for secondary surgery and high costs. Autologous matrix-induced chondrogenesis technology has shown promising effectiveness in the treatment of primary and non-primary OLT and OLT with large defect and subchondral bone cysts. However, there is a scarcity of relevant studies, most of which exhibit low quality. Adjuvant therapy utilizing biological agents represents a novel approach to treating OLT; nevertheless, due to insufficient support from high-quality studies, it has not exhibited significant advantages over traditional treatment methods. Furthermore, its long-term effectiveness remain unclear.
Conclusion: The optimal choice of surgical treatment for OLT is contingent not only upon the characteristics such as nature, size, and shape but also takes into consideration factors like advancements in medical technology, patient acceptance, economic status, and other pertinent aspects to deliver personalized treatment.
目的: 总结距骨骨软骨损伤（osteochondral lesion of talus，OLT）外科治疗方法，为临床治疗提供参考。.
方法: 广泛查阅国内外近年相关研究文献，总结OLT各外科治疗方法的优势和局限性。.
结果: 目前治疗OLT的手术方式较多，均能获得良好疗效，但也各有利弊。骨髓刺激术治疗损伤直径<15 mm的原发性OLT能在短期内改善症状，但远期疗效欠佳。自体骨软骨移植（autologous osteochondral transplantation，AOT）、同种异体骨软骨移植（osteochondral allograft transplantation，OAT）适用于损伤面积较大并伴有软骨下骨囊变的OLT，然而骨与骨之间不完全解剖匹配可能会形成新的软骨下骨囊变，其中AOT还存在供体部位并发症问题。与AOT、OAT不同，同种异体幼年软骨微粒移植无需进行额外截骨术，且幼年软骨能向软骨缺损部位输送有活力的软骨细胞，修复组织能力优于成年软骨。细胞移植术治疗OLT可取得满意疗效，但存在需两次手术、价格昂贵等问题。自体基质诱导软骨形成技术治疗原发性及非原发性OLT、大面积病变和伴有软骨下骨囊变的OLT都表现出满意效果，但目前相关研究较少且大多质量不高。生物制剂辅助治疗是治疗OLT的新方式，但疗效缺少高质量研究支持，对比传统治疗手段也未显现出明显优势。.
结论: OLT外科治疗方法的选择不仅取决于其性质、大小、形态，还应考虑医疗技术水平以及患者接受程度、经济状况等因素，以提供个性化治疗。.
Keywords: Talus; osteochondral lesion; surgical treatment.