Topic 20 · Everything else
Revision Surgery Outcomes
The central question for this ankle. Success drops with each revision, and the 806-ankle non-primary review is the best evidence that exists.
→ "Revision" = doing surgery again after a first surgery failed. Success rates are lower than first-time surgery. The more revisions, the harder it gets.
2024 Comprehensive Revision Systematic Review (50 Studies, 806 Ankles)
The largest pooled analysis of non-primary OLT procedures to date [148]:
- OAT remained one of the better-performing non-primary procedures
- ACI had the best pooled PRO performance but tiny dataset (only 7 ankles)
- OCA and HemiCAP looked less effective as revision procedures
BMS for Non-Primary/Revision OLT
A systematic review found concerning outcomes for revision cases [21]:
2026 Non-Primary BMS Prospective Study
A new 2026 prospective study confirmed that non-primary BMS improves patients from baseline but still underperforms primary cases at 2 years [149].
Realignment Surgery for Failed OAT (2024)
When osteochondral autograft transplantation fails with concomitant malalignment [134]:
- Spontaneous restoration of OLT can occur after realignment surgery
- Cyst volume decreased from 0.2592 to 0.0873 cm³ (p<0.05)
- Clinical scores improved in all patients with realignment
Repeat Arthroscopy and Microfracture (2024)
A study on repeat procedures found [135]:
- Moderate satisfaction: 7.6/10
- Moderate residual pain: 4.7/10
- 21% required additional surgery after repeat microfracture
2026: The Nerve-Injury Risk of the Arthroscopy Itself (545 Procedures)
→ This is not about whether a repair works. It is about the numbness and burning that can follow simply from the camera portals — a risk that applies to every option on this page, because they all start with an arthroscopy.
A retrospective cohort of 545 consecutive ankle and hindfoot arthroscopies at a single referral centre (October 2023–May 2025) tracked sensory nerve complications and, unusually, followed their course [238]:
- Symptoms appeared within 48 hours in 64.4% of affected cases
- Smoking and a non-anterior surgical approach were independently associated with nerve injury
- Higher residual pain intensity and neuropathic pain features (S-LANSS ≥12) predicted a lower chance of spontaneous recovery — meaning the character of the pain early on carries prognostic information
- The authors state plainly that this is a longer course than traditionally assumed
Why this belongs on this page. Every option still under consideration — the MASCOT trial, osteochondral autograft, bone marrow stimulation, TOPIC, a diagnostic look-and-see, even a “just clean it out” procedure — begins with an ankle arthroscopy. The rate itself is in the range usually quoted; the finding that matters is that fewer than half of those affected were fully better more than a year later. That reframes portal nerve injury from a transient nuisance into a real and reasonably common cost that belongs in the decision, and it is a specific question worth asking any surgeon proposing a procedure: what is your rate, and by what approach. Caveats: Level IV, retrospective, one centre, and a mixed case load rather than isolated talar lesions — so the absolute percentage may not transfer even if the recovery pattern does.
Key point: Revision success rates are consistently lower than primary surgery. The 2024 pooled review shows OAT and ACI outperform OCA and HemiCAP in revision settings, but all revision approaches carry meaningful failure risk.