Osteochondral lesions of the talus (OLTs) are areas of abnormal, damaged cartilage and subchondral bone on the surface of the talus. They vary in size and are encountered on the medial and lateral domes of the talus. Because of the tenuous blood supply of the talus, OLTs are associated with poor healing potential and may lead to progressive degenerative changes of the ankle joint. After nonsurgical treatment options have been exhausted, cartilage restoration procedures can be considered. Osteochondral allograft transplantation is a reliable, reproducible treatment option for the management of large OLTs. Perpendicular access to an OLT is critical for successful graft implantation. Accessing the lateral talar dome may be a challenge. Fibular osteotomy is a safe and reliable method for exposure of the lateral talar dome.

This video demonstrates fresh osteochondral allograft implantation for management of a large OLT via a fibular osteotomy. The video discusses the case presentation of a 43-year-old man with a large traumatic lateral OLT. The patient underwent a modified Broström procedure 2 years prior to presentation. The patient had persistent symptoms, and advanced imaging studies revealed a large lateral OLT. This video provides an overview of the pathogenesis, diagnosis, and management of OLTs and discusses the indications for osteochondral allograft transplantation. In the patient shown in this video, the lateral talar dome was accessed via a fibular osteotomy. Excellent restoration of the talar articular surface was achieved intraoperatively. The osteotomy site healed uneventfully. The patient was advanced through a standardized rehabilitation protocol with gradual relief of his symptoms. Patients with a lateral talar dome osteochondral lesion in whom nonsurgical management fails can be successfully treated via osteochondral allograft transplantation. Implantation requires adequate exposure of the lateral talar dome via fibular osteotomy.