Abstract
The diagnosis of Osteochondral Chondral Lesion of the talar dome is ever more regularly made. Though algorithms of management have emerged by recognising the position, size and the most reliable treatment options, the problem of the failed or relapsed case has only been considered in limited publications.
When considering the failed case a variety of possibilities have to be considered.
The characteristics of the patient have to be considered. The nature of the original presentation and the history of the present as opposed to the past compliant are worth noting. Patients who have no history of trauma do seem to have a different natural history and response to treatment. The young and the old may well respond differently.
Factors preventing recovery from surgery such as ongoing instability of the ankle or hindfoot deformity creating on going abnormal pressures on the joint surface should be looked for.
The possibility that the surgery undertreated or missed the full nature of the lesion has to be considered. The possibility of an untreated further pathology should be reviewed.
The severity of the original lesion and it's likely response to treatment should be considered. Larger cystic lesions would be more likely to have a poorer outcome. Ultimately if there are persistent symptoms and evidence of ongoing unresolved pathology on the joint surface alternative techniques to resurface the joint should be considered.
