Osteochondral grafting the talus
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Autologous osteochondral grafting of the Talus is normally reserved as a secondary procedure after failed microfracture.
Though there is some evidence that the high grade lesions do less well with debridement and microfracture this is a much smaller operation than open grafting and a number will settle with no more intervention required.
It is key that the Osteochondral grafts are placed as precisely (and flush) with the existing articular surface as possible which in most cases means a Malleolar osteotomy (either medial or lateral) will be required.
Secondary interventions are also on occasion required post grafting and a return to normal and full function is not likely for at least 6 months.