Editorial Commentary: All-Arthroscopic Autologous Cancellous Bone Transplantation for Hepple V Cystic Osteochondral Lesions of the Talus-High Impact With Lower Level Evidence.

Osteochondral lesions of the talus that have failed nonoperative management can be treated via a variety of surgical modalities. In the case of large lesions with substantial chondral or subchondral involvement, such as Hepple type V cystic lesions, cartilage-replacing procedures have provided favorable outcomes at the expense of necessitating open arthrotomy and malleolar osteotomy, which can be debilitating to patients. Several recent reports with lower level of evidence have described favorable outcomes for even severe large cystic osteochondral lesions of the talus when treated with all-arthroscopic autologous cancellous bone transplantation. Given the benefits associated with arthroscopic treatment, further investigation to determine the type of osteochondral lesions of the talus that can be optimally treated with this surgical modality, rather than an open procedure, is warranted.