Treatment of Osteochondral Lesions of the Talus With Bone Marrow Stimulation and Chitosan–Glycerol Phosphate/Blood Implants (BST-CarGel)  Jesús Vilá y Rico, M.D., Ph.D., Antonio Dalmau, M.D., Francisco Javier Chaqués, M.D., Jordi Asunción, M.D.  Arthroscopy Techniques  Volume 4, Issue 6, Pages e663-e667 (December 2015) DOI: 10.1016/j.eats.2015.07.008 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 An osteochondral lesion of the talus amenable to treatment with BST-CarGel. (A) Coronal T1- and T2-weighted fat-saturated magnetic resonance images of a right ankle showing a cartilage defect in the talus (arrows). (B) Arthroscopic view of the right ankle from the anteromedial portal with the patient placed in the supine position. The arrows indicate the chondral lesion. (MM, medial malleolus; T, talus; TB, tibial plafond.) Arthroscopy Techniques 2015 4, e663-e667DOI: (10.1016/j.eats.2015.07.008) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Key surgical steps for arthroscopic treatment of osteochondral lesions of the talus with bone marrow stimulation and BST-CarGel. Arthroscopy is performed in a left ankle, with the patient placed in the supine position. The anteromedial portal is used as the viewing portal. (A) Arthroscopic view showing the chondral defect after debridement of unstable cartilage and fibrous tissue at the base of the lesion and the cartilage that lies immediately adjacent to the defect. Debridement is also performed to obtain well-defined, stable margins between healthy cartilage and the chondral defect. The calcified layer is then carefully removed to expose the subchondral bone. (B) Once the healthy vascularized subchondral bone is exposed, holes measuring 1 mm in radius and 9 mm in depth (arrows) are made with the Arthrosurface NanoFx instrument. (C) With the tourniquet still applied to the upper thigh, irrigation is stopped and small swabs and gauzes, introduced through a cannula, are used to completely dry the lesion bed. (D) Arthroscopic view of the surgically prepared area before BST-CarGel application. (E) BST-CarGel is applied preferably using large 18-gauge needles in a drop-by-drop manner until the defect area is completely filled. After delivery, a waiting period of 15 minutes ensures that the implant clots in place. (F) View of the completed repair after BST-CarGel application. (MM, medial malleolus; T, talus; TB, tibial plafond.) Arthroscopy Techniques 2015 4, e663-e667DOI: (10.1016/j.eats.2015.07.008) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions