Particulated Juvenile Articular Cartilage Graft (DeNovo NT Graft) for Treatment of Osteochondral Lesions of the Talus

OLT, particularly lesions having already failed a reparative treatment approach such as arthroscopic lavage, abrasion chondroplasty, or microfracture chondroplasty, represent a relatively difficult treatment dilemma for even the most experienced foot and ankle surgeon.” “ Osteochondral lesions of the talus (OLT) are not uncommon, frequently associated with recurrent instability of the ankle and acute ankle fractures. The specific etiology of the OLT is sometimes unclear, with only a subtle injury responsible for the lesion. Imaging studies such as plain film radiographs and magnetic resonance imaging are mainstays of the clinical evaluation. Only 45% of OLT will successfully respond to conservative, nonoperative treatment; therefore, the foot and ankle surgeon must have a broad understanding of reparative and restorative techniques to address this challenging entity. OLT, particularly lesions having already failed a reparative treatment approach such as arthroscopic lavage, abrasion chondroplasty, or microfracture chondroplasty, represent a relatively difficult treatment dilemma for even the most experienced foot and ankle surgeon. In addition to reparative techniques for treating OLT, there are restorative techniques for treatment, including autologous or allogenic osteochondral transplantation (OATS), autologous chondrocyte implantation (ACI), and matrix-induced autologous chondrocyte implantation (MACI). The evolution of fresh cartilage handling techniques has resulted in a new option in cartilage restoration—minced articular cartilage. Selecting the most appropriate treatment strategy depends not only on a surgeon’s experience but also on other variables, including a lesion’s size, whether or not it is a contained or an uncontained defect, the lesion’s location on the talar dome, and any previous surgical procedures. Previous experience has strongly correlated size of the OLT with prognosis. Lesions greater than 1 cm and uncontained shoulder lesions are among the more difficult lesions to treat. A combination of plain film radiographs, magnetic resonance imaging, and diagnostic arthroscopy are helpful in determining the most appropriate treatment approach for OLT. Articular cartilage is highly susceptible to injury and often refractory to spontaneous healing due in part to its lack of vascularity and absence of available progenitor cells. Although talar articular cartilage shares many similarities with articular cartilage found elsewhere in the body, including its microscopic structure, it has some unique macroscopic proper-