Question
Hi Doc.
i have a medial lesion of the talar dome in left ankle measuring c1.2cm2. i had microfracture 4yrs previously (at age of 24) which substantially reduced pain and i could return to a reasonable level of exercise. Mid 2007 i started to feel the same pain and in Oct 2007 i had a 2nd microfracture - 6mths on and i am still in the same pain -OS has acknowledged this 2nd op was not a success. i am now at the 'what next' stage? i would like to ask you what you believe my next step should be. OATs, ACI, Hemicap implant, wait for future advances, further Microfracture?
I can provide further info if this will help.
Many thanks and kind Regards.
Marcus, Yorkshire UK

Answer
Hi Marcus,

At your age I would consider ankle procedures for your talar dome lesion that either prolong your function or add cartilage to the talus.  Many of the procedures that you mention are mostly studied and performed in the knee but can translate to the ankle.

Another microfracture would certainly be a consideration.  After that I would consider the OATS rather than ACI.  I believe the success rate is better.  I would avoid any joint implants or joint destructive procedures because you are too young.

Good Luck.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


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