There are many different options to treat cartilage defects in the ankle as discussed previously. Common methods include debridement with abrasion and microfracture. Microfracture is still the recommended treatment option for osteochondral lesions (OCLs) under 2.5cm2 but it is not regarded as an acceptable treatment for bigger lesions.
The OATS (osteochondral autologous transplantation) procedure is still probably the gold standard for larger or persistent talar dome lesions. However success rates of OATS are still in the region of 85-90%, and the donor site (typically the same side knee) may remain painful after the procedure in some patients (10-30%) . AMIC is a new method which combines subchondral microfracture, and or bone grafting with the fixation of a collagen type I/III matrix called Chondro-Gide) by a partially autologous fibrin glue.
It is a relatively new procedure but one which has shown major post-operative improvements in the literature. The surgeon starts by reducing the defect with a curette, beginning micro fracturing the talar dome and measuring the lesion with the guide provided with the Chondro-Gide. The matrix is then moistened with sterile water and applied to the OCL. A layer of fibrin glue is then put over the lesion and the area is held in position to allow it to dry.
The operation is generally an open procedure so is a little more invasive than arthroscopic OCL repair but the latest research is showing it is significantly better than debridement and micro fracture alone.
The patient will be put into an air cast boot immediately after the procedure and will wear the boot for approximately 6 weeks. During this time it is important to partake in physiotherapy to avoid any unnecessary restrictions in movement.