An individualized and evidence-based approach to osteochondral lesions of the talus: in-depth focus on the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) technique

An osteochondral lesion of the talus (OLT) is defined as damage of the cartilage layer and its subchondral bone. To date, several surgical treatment strategies have been described in order to restore the cartilage and its subchondral bone. Despite the good clinical results, each surgical strategy has its pros and cons. In order to avoid several potential downsides for large primary and secondary OLTs, a new replacement technique is developed. In the present concepts review, it is the aim of the authors to describe the treatment and diagnostic approach that is contained in the Amsterdam evidence-based algorithm for OLTs. It is also our aim to discuss the rationale for the development of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) technique and describe the indications, surgical technique and initial. The content of this current concepts review is based on the Amsterdam Approach in treating different types of OLTs. A comprehensive explanation, including the rationale for, and description of the novel TOPIC technique will be set out. Additionally, the clinical results of ten patients are reported which are obtained from the only PubMed indexed papers. The Amsterdam Approach contains bone marrow stimulation (BMS), fixation and the novel biologic replacement TOPIC technique depending on lesion size and morphology. The TOPIC technique uses a personalized graft which is harvested from the iliac crest. The most important favor of this technique is its personalized approach. The clinical results of this current concepts review are based on the first pub-med indexed publication of this newly described technique. Both physical and mental improvements were observed at one year follow-up. Additionally, radiographs showed good consolidation of all osteotomies, and good incorporation of the press-fit graft. These current concept reviews describe an integrated surgical approach to the treatment of OLTs with the presentation of a new technique, the TOPIC technique. The first results of this technique are promising, however, more research in a larger population is needed in order to make firm conclusions.