{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:03:23Z","timestamp":1789077803520,"version":"build-2803163510"},"reference-count":82,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:00:00Z","timestamp":1728950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I\u2013II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III\u2013IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis\/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR.<\/jats:p>","DOI":"10.3390\/medicina60101692","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T05:49:48Z","timestamp":1729230588000},"page":"1692","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2311-7389","authenticated-orcid":false,"given":"Micha\u0142 Jan","family":"Kubisa","sequence":"first","affiliation":[{"name":"Orthopedic and Traumatology Department, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta Gabriela","family":"Kubisa","sequence":"additional","affiliation":[{"name":"Orthopedic and Sport Traumatology Department, Carolina Medical Center, 02-757 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-2896","authenticated-orcid":false,"given":"Karol","family":"Pa\u0142ka","sequence":"additional","affiliation":[{"name":"Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3895-0149","authenticated-orcid":false,"given":"Jakub","family":"Sobczyk","sequence":"additional","affiliation":[{"name":"Orthopedic and Sport Traumatology Department, Carolina Medical Center, 02-757 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Bubie\u0144czyk","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Department, Pomeranian Medical University, 70-204 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9799-5750","authenticated-orcid":false,"given":"Pawe\u0142","family":"\u0141\u0119gosz","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Department, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,15]]},"reference":[{"key":"ref_1","first-page":"110","article-title":"Fractures and dislocations of the talus","volume":"92","author":"Hendrich","year":"1989","journal-title":"Unfallchirurg"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/107110078300400204","article-title":"The arterial anatomy of the talus","volume":"4","author":"Gelberman","year":"1983","journal-title":"Foot Ankle"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1148\/rg.252045709","article-title":"Avascular Necrosis of the Talus: A Pictorial Essay","volume":"25","author":"Pearce","year":"2005","journal-title":"RadioGraphics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.fcl.2008.09.004","article-title":"Posttraumatic Avascular Necrosis of the Talus","volume":"13","author":"Clare","year":"2008","journal-title":"Foot Ankle Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.fas.2017.04.008","article-title":"Fractures of the talus: Current concepts and new developments","volume":"24","author":"Buza","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_6","unstructured":"Berruex, P., Blatter, R., Boitzy, A., Cehner, J., Kern, F., Liechti, R., Magerl, F., Marti, R., Mehmann, P., and Morger, R. 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