A posterior tibiotalar dislocation with a posterolateral talar dome osteochondral defect is identified on CT scan. After closed reduction, the osteochondral fragment is displaced > 5 mm and the lesion is > 15 mm in diameter. The most appropriate management is:

• A Non-weight-bearing cast for 8 weeks with serial radiographic follow-up
• B Arthroscopic debridement and microfracture of the talar dome lesion
• C Total ankle replacement
• D Osteochondral autograft transfer (OATS/mosaicplasty) for large displaced lesions ✓

Explanation

Osteochondral lesions of the talus (OLT) > 10–15 mm or those with displaced fragments > 5 mm are poor candidates for conservative management or microfracture (which produces fibrocartilage rather than hyaline cartilage). Osteochondral autograft transfer (OATS/mosaicplasty) is the preferred technique for larger, cystic, or failed microfracture lesions, providing durable hyaline cartilage restoration. Allografts or autologous chondrocyte implantation are alternatives for very large lesions.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.