Special Focus: Osteochondral Lesions of the TalusStructural Allograft Reconstruction for Large Osteochondral Lesions of the TalusEasley, Mark E. MD; Adams, Samuel B. Jr MD; DeOrio, James K. MD; Nunley, James A. II MDAuthor Information Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC The authors declare no conflict of interest. Address correspondence and reprint requests to Mark E. Easley, MD, Department of Orthopaedic Surgery, Duke University Medical Center, Box 2950, Durham NC 27710. Techniques in Foot & Ankle Surgery: December 2011 - Volume 10 - Issue 4 - p 148-158 doi: 10.1097/BTF.0b013e31823a14be Buy Metrics Abstract Most osteochondral lesions of the talus (OLTs) may be managed successfully with arthroscopic debridement in combination with either microfracture or drilling. However, treatment with debridement and microfracture/drilling tends to be less reliable in large OLTs, OLTs associated with loss of the talar shoulder architecture, and OLTs associated with large subchondral cysts. When the talar shoulder is compromised due to a large OLT, then a structural graft may be considered to reconstruct the deficient portion of the talar dome. In this situation, fresh and fresh-frozen allograft tali have been used. Although reports of structural allograft reconstruction for the talar dome are sparse, the limited literature on this subject suggests that successful outcome is feasible. This article focuses on our experience with structural allograft reconstruction for large OLTs. © 2011 Lippincott Williams & Wilkins, Inc.