Referred to a surgeon, and looking for advice

[toobusyforthis]

OCD and I go way back!  I was diagnosed 4 years ago with it and was treated with cortizone shots when it acted up and anti-inflamatory drugs.  It worked pretty well.  Until just last July when I fell, heard my ankle crack (yep the same ankle) and went to the ER.  At this point, they diagnosed me with an ankle sprain and still the presence of the OCD. Unfortunately, my Ortho dropped our insurance and I had to see another Dr.  Since July I've been in an aircast and every night my ankle is sore and swollen.  I went back to my new Ortho, who ordered another MRI to compare the injury to the July scan.  He told me that the lesion had gotten bigger and the cartlidge was falling into the cyst and he was referring me to a surgeon.  So, with that said, I'm EXTREMELY frustrated.  This is effecting my everyday activities.  So, with this visit around the corner to the new surgeon, I'm trying to compile a list of questions, and that's where I turn to you!  I'm concerned very much about whether going through the pain, recovery and NWB will really make a difference, especially after reading so many posts here.  Besides the swollen tendons, my latest MRI reads,
"The talar dome defect is evolving. There is a stable zone of surrounding edema overall but the size of the lesion involving the medial talar dome is slightly larger and more importantly the corical line is now collapsing , suggesting that the focus is beginning to cavitate. Minimal amount of joint fluid." 
It also says, that the defect is 10 mm x 10 mm.

Is this a big lesion? This is the THIRD Dr. and I want to go in armed with info and advice from other patients before I commit to the rehabilitation of surgery.  I'm a mom of two young kids, and a teacher...the rehabilitation is going to be hard to keep me down!

[airjaw]

Hello!
Sorry to hear about your OCD.

First I would recommend going to the absolute best ankle surgeon/ doctor you can find, even if that means flying across the country. The extra money is worth it because we are talking about your body and your quality of life.

As for surgeries, there are several options. The first option is to not get surgery at all. This is conservative and can work if your ankle is not deteriorating and you are able to live with it.

The second is to get microfracture, where they drill your bone to let blood flow out and create scar cartilage.  Recovery: 6 months to a year.

The third and most invasive procedure is OATS. Recovery is long and painful. Probably minimum 1 year.

10mm x 10mm is a fairly large lesion. The larger the lesion the less likely microfracture will work. But your doctor can give better information about your particular case.

The note about your corical  (cortical?) line collapsing worries me. I would ask the doctor for more information about that. My guess is that your ankle stability could be getting worse and you might need to take aggressive steps to fix it.

Again, talk to your doctor! And goodluck. Let us know if you have any more questions.

[katytex]

I had the same sized defect and cyst and had arthroscipic abrasion surgery in May and I'm running again with no pain or swelling.  First Dr. reccomended OATS, but I found another Dr. that reccomended abrasion first and even a second time before OATS.  My defect was however centrally located and so I have good cartalige around the repair, a lot of people have a defect on the edge of the talus which can be hard to repair with arthrosopic surgery.  Surgery can work though, and you need to consider that if you don't have surgery the deffect can grow and become worse.  Mine doubled in size over a year, but I didn't reduce my activity level.