Osteochondritis Dissecans of the Talus - OATs Post Op

Posted by momamiya @momamiya, Jun 15 12:42am

Hi! I am a 38yr old female 4 months post-op of my 2nd OATs procedure (6 in total over the last 10 years with previous 2 ATFL surgeries, muscle correction with tendon repair and arthroscopic cartilage repair), and this time pain and coinciding mobility issues are increasing. Chronic pain 12+ years.

-No official PT was advised as my ligaments and tendons tear very easily but daily ROM exercises are being done at home.
-Last X-ray results at 3 months post-op FINDINGS: Medial plate and screw fixation of prior medial malleolar osteotomy
is without evidence of hardware complication. There are ongoing signs of
healing at the surgical line. Alignment is normal. There is however a
subchondral cyst formation of both the talar dome and tibial plafond Mild
degenerative changes of the posterior talocalcaneal joint, similar to prior.
Mild soft tissue swelling about the ankle.
-Surgeon prescribed Gabapentin to see if that would assist with pain no changes yet. A second surgical opinion told me I will never walk properly again and out of all the things he has dealt this is the one condition he would never want.

Looking for opinions or references; I have never met anyone else with an OCD/multiple OATs. Will try almost anything/go anywhere for pain resolution that will let me run around with my kids.

Thank you!

Hi @momamiya, and welcome to Mayo Clinic Connect!

I think @bridgetc14 would be a great connection as she has expressed difficulty with what you are going through to an extent.

Here are a couple of references you may be interesting in reading.
Osteochondritis dissecans of the talus:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295677/
Physical Therapy Guide to Osteochondritis Dissecans:
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-osteochondritis-dissecans
I would like to ask, @momamiya, how you feel personally and for you to explain your situation from your point of view? Just so other members can resonate with your actual experience and not just a doctors diagnosis. Would you be willing to share that?

REPLY
@amandaburnett

Hi @momamiya, and welcome to Mayo Clinic Connect!

I think @bridgetc14 would be a great connection as she has expressed difficulty with what you are going through to an extent.

Here are a couple of references you may be interesting in reading.
Osteochondritis dissecans of the talus:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295677/
Physical Therapy Guide to Osteochondritis Dissecans:
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-osteochondritis-dissecans
I would like to ask, @momamiya, how you feel personally and for you to explain your situation from your point of view? Just so other members can resonate with your actual experience and not just a doctors diagnosis. Would you be willing to share that?

Jump to this post

Thank you! @amandaburnett – I definitely can elaborate personally…The last 9 years have held 5 ankle surgeries with 4 of them in just the last couple years with less and less time til the next one, it was only 7 months in between the last. Whether it be my age, my ankle is just that bad or another reason; recovery and getting any type of pain relief is getting harder which is affecting mobility impacting quality of life. Currently after my OATs on 2/12/21 every time I weight bear there is a very intense burning/throbbing pain that wraps around the front of my ankle and if I’ve done to much during the day it effects when at rest as well; I am a person with a very high pain tolerance.so this is not something light. Trying to find a surgeon who will listen to my story and be willing to work with me on a more permanent solution or at least less frequency between each surgery (as I know OATs is not a permanent fix for Osteochondritis Dissecans) feels like an impossibility. I was never that athletic but always active with walking or yoga or hiking and now a days the most I can do is walk around the block before I’m to swollen or the pain is to intense…I really don’t mean to be all doom and gloom just at a point of total frustration.

REPLY

Group,
New to this site but really struggling. My son (baseball/football player) has been having ankle pain. The MRI revealed a 3cm lesion on the inside part of his talar dome. This was uncovered by our podiatrist who is trained in foot/ankle and does surgeries.

My problem is this. He sent me off to get a second opinion. And the second opinion was wildly different approach from the first. The podiatrist recommends the approach of using cadavar cartilage to fill in the crack and glue over. The orthopedist is recommending the OATS(?) procedure which is the microfracturing of the area to create scar tissue to fill it in.

I am hearing different things about the agressiveness of one method over the other and the ortho approach being more conservative but maybe winds up at a second surgery if it doesn't work.

In short, I am very unsure about next steps. Who should I have do what procedure? Ortho or podiatrist? The ortho we saw today is wanting to operate next week! Both are saying this will never heal on its own. I am getting a third opinion next week also with a different ortho but who knows what that will bring.

Any and all recommendations are very much appreciated.

Len

REPLY
@lentoc

Group,
New to this site but really struggling. My son (baseball/football player) has been having ankle pain. The MRI revealed a 3cm lesion on the inside part of his talar dome. This was uncovered by our podiatrist who is trained in foot/ankle and does surgeries.

My problem is this. He sent me off to get a second opinion. And the second opinion was wildly different approach from the first. The podiatrist recommends the approach of using cadavar cartilage to fill in the crack and glue over. The orthopedist is recommending the OATS(?) procedure which is the microfracturing of the area to create scar tissue to fill it in.

I am hearing different things about the agressiveness of one method over the other and the ortho approach being more conservative but maybe winds up at a second surgery if it doesn't work.

In short, I am very unsure about next steps. Who should I have do what procedure? Ortho or podiatrist? The ortho we saw today is wanting to operate next week! Both are saying this will never heal on its own. I am getting a third opinion next week also with a different ortho but who knows what that will bring.

Any and all recommendations are very much appreciated.

Len

Jump to this post

Hello @lentoc and welcome to Mayo Clinic Connect. I can see how difficult this decision is for you, especially given the vast difference in your options and recommendations and the mere fact that your son is 15 years old (per your original title of that post).

You will notice that I have moved your post into an existing discussion discussion on a similar topic so you can connect with @momamiya to learn from one another.

Are you feeling pressured by the timeline of surgery next week?

REPLY
@amandajro

Hello @lentoc and welcome to Mayo Clinic Connect. I can see how difficult this decision is for you, especially given the vast difference in your options and recommendations and the mere fact that your son is 15 years old (per your original title of that post).

You will notice that I have moved your post into an existing discussion discussion on a similar topic so you can connect with @momamiya to learn from one another.

Are you feeling pressured by the timeline of surgery next week?

Jump to this post

Most assuredly I am feeling pressured by the timeline. I am being told that the cartilage never heals on its own and until we do something he will just live in pain.

REPLY
@lentoc

Most assuredly I am feeling pressured by the timeline. I am being told that the cartilage never heals on its own and until we do something he will just live in pain.

Jump to this post

@lentoc I completely understand the pressure you must be under with this decision and the vastly different approaches you have to choose from.

Here are some reference articles that you may find helpful as you make your decision on what you feel is best to pursue.

– A Proposed Treatment Algorithm For Osteochondral Lesions Of The Talus: https://www.hmpgloballearningnetwork.com/site/podiatry/proposed-treatment-algorithm-osteochondral-lesions-talus

– Diagnosis and treatment of osteochondral lesions of the ankle: current concepts: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091026/

– Osteochondral Autologous Autograft – (OATs Procedure): https://footeducation.com/osteochondral-autologous-autograft/
"When compared to OATS/mosaicplasty, allograft has no donor site morbidity, … Additional surgery after the index procedure is common, with ankle …"

– Osteochondral Allograft of the Talus:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127728/
Will you come back and share the direction you feel you are leaning and share updates in case members are able to lend their experiences and support as you walk through this journey?

REPLY
@amandajro

@lentoc I completely understand the pressure you must be under with this decision and the vastly different approaches you have to choose from.

Here are some reference articles that you may find helpful as you make your decision on what you feel is best to pursue.

– A Proposed Treatment Algorithm For Osteochondral Lesions Of The Talus: https://www.hmpgloballearningnetwork.com/site/podiatry/proposed-treatment-algorithm-osteochondral-lesions-talus

– Diagnosis and treatment of osteochondral lesions of the ankle: current concepts: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091026/

– Osteochondral Autologous Autograft – (OATs Procedure): https://footeducation.com/osteochondral-autologous-autograft/
"When compared to OATS/mosaicplasty, allograft has no donor site morbidity, … Additional surgery after the index procedure is common, with ankle …"

– Osteochondral Allograft of the Talus:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127728/
Will you come back and share the direction you feel you are leaning and share updates in case members are able to lend their experiences and support as you walk through this journey?

Jump to this post

Thank you very much for those articles. Very insightful and Informative but also reinforcing why there is such a difference in opinion. There seems to be multiple methods to treat this issue but I can’t tell which way would provide the best outcome.

We have another opinion with an ortho surgeon tomorrow who was referred by the podiatrist. I will be interested to see what his approach is.

As far as how I am leaning I don’t think I can say. It doesn’t feel right to me that we are out in this situation to make a choice based on what little understanding I have of the situation. This is a high level baseball/football player with a promising future if healthy. He’s played all over the country and is ranked in his age group by several organizations. But he is just 15 and I hate that he is going through this.

REPLY

Just an update. Amanda thank you very much as those articles were tremendous and helped me a great deal.

My son is in surgery as I write this. Doing a debreidement with a micro fracture and allograft with stem cells from the hip. Bio cartilage in there somewhere. Praying it goes well.

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