J Korean Foot Ankle Soc.  2020 Jun;24(2):69-74. 10.14193/jkfas.2020.24.2.69.

If the Patient Complains Persistent Pain after the Operation, What Should We Do?

• Lee H
• Sung KS

• KMID: 2502912
• DOI: http://doi.org/10.14193/jkfas.2020.24.2.69

Abstract

Osteochondral lesions of the talus (OLT) can heal and remain asymptomatic, or they can progress to deep ankle pain on weight bearing and the formation of subchondral cysts. Treatment varies from nonoperative treatment to open and arthroscopic procedures. Operative procedures include marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autografts or allografts, and autologous chondrocyte implantation. Among these treatments, arthroscopic marrow stimulation techniques have been the preferred initial surgical treatment for most OLT. Despite these treatments, many patients complain of persistent pain even after surgery, and many surgeons face the challenge of determining a second line of treatments. This requires a thorough re-evaluation of the patient’s symptoms as well as radiological measures. If the primary surgical treatment has failed, multiple operative treatments are available, and relatively more invasive methods can be administered. On the other hand, it is inappropriate to draw a firm conclusion in which methods are superior.

Keyword

Osteochondral lesion of talus; Failed primary treatment; Osteochondral lesion; Repeat arthroscopy

Figure

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  Figure. 1 Insufficient treatment; remaining loose body on posterior of talus (arrows).

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  Figure. 2 Insufficient treatment such as incomplete removal of bad tissue (A), too shallow drilling (B), too deep drilling (C) (in order) can be possible causes of failed pain relief.

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