Kaplan P. Musculoskeletal MRI. I got a second opinion from an orthopedic surgeon closer home and he didn’t think that was necessary and suggested an arthroscopy and debridement. I’m traveling an hour and a half to see him and I feel it is worth it. Cortisone shot,brace and boot did not work. You’ll need to get a repeat evaluation. Osteochondritis Dissecans is an acquired joint defect which involves the subchondral bone and the overlying articular cartilage. Sincerely I have been dealing with this for close to 7 months. Occasionally bone grafting is indicated in unstable lesions that do not have significant joint congruity to allow restoration of articular congruency and enhance the healing potential. Radiology. If you need another opinion one of the the ROCK members could either see you or at least get you to someone that could give some good advice. Children can normally return to sports after 2 to 4 months. A history of locking, catching or ankle sprains on multiple occasions is common. The most commonly used system for classifying OCD lesions was presented by Berndt and Harty in 1959, with additional staging described by Scranton and McDermott in 2001. OCD usually causes pain during and after sports. I had my X-Rays and the doctor said that there is nothing on my foot. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Had the preop appt. W B Saunders Co. (2001) ISBN:0721690270. Rarely are there any limitations of joint range of motion. Thanks. Unable to process the form. Since the lesion is 7 x 4.5 x 11 mm. My concern now it that the “catching” and pain is back and my ankle seems to give out more. Routine x-rays of the ankle can easily miss a small osteochondritis dissecans lesion, so it often goes undiagnosed for a long period of time. However, I really love to jump and want to finish my last year as well as possible. I am sorry to hear about your daughters talus OCD. OCD can run in families, but often it does not. Kate did you ever get an answer and did you make it thru your senior season? I don’t want another surgery. 2. With that in consideration, embarking on a period of non-surgical management is ideal, but the results in the literature suggest that you should be prepared to proceed with surgical intervention if this treatment fails. The goals of operative treatment are the same as the goals for non-operative management. Fresh osteochondral allograft is a procedure which is done on very large lesions. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. If the surgical treatment is well matched to the specifics of the lesion the success can be around 80 to 90%. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children. Some days are mine, some days I feel too much pain. Medical College of Wisconsin[/box], Dr. Ben Heyworth is an Orthopedic Surgeon specializing in Orthopedic Surgery, Drilling is also an arthroscopic procedure to promote stimulation of the underlying bone. 3. We think that it is at least partially caused by a change in the blood flow in the bone around a joint that makes the bone sick. only advice is if at all possible, (i do not know where you live) go to Rothman Institute in the Philadelphia Pa. area. Unfortunately the pain has become unbearable and I am now facing surgery. They did xrays and an MRI and concluded my pain is from arthritis and the limited mobility is because I had a tarsal coalition as a child. Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. Treatment principles of osteochondral lesions of the ta… account for 13-23% of talus fractures; lateral process fractures . I am very grateful I opted for that because I think my outcome has been better, but initially I had a great deal more pain. While the recovery time with an arthroscopy was much shorter I did see in my research that the larger lesions responded better to mosaicplasty so I opted for that procedure. This softening is caused by an interruption in the blood flow to that portion of the bone. Dr. Lyon, I’m glad that I came across your blog on ankle OCD where you offered insights on this condition for kids. Good Luck. The pain is very minimal when I walk around, but is much much higher when I jump and is impacting my jumping significantly. There is an increasing prevalence of this condition in athletic teenage girls. Surgical attempts to improve the healing of the osteochondritis dissecans lesion to the native bone, stabilize loose fragments or to replace defective tissue with either an autograft or allograft transfer osteochondral tissue. These techniques however have limited clinical outcome data in the adolescent and children. Fracture of the lateral process of the talus in snowboarders. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. The surgery may have been 17 years ago but I remember a little and what I remember is that they went in there to replace or repair some cartilage between two bones that were rubbing together that shouldn’t have been and that’s what was causing my pain, my constant twisting my ankle, and falls because my ankle would go out on me. If you don’t mind I would like to ask if you really went that way and if you could share your experience. Fixation of these lesions can be performed using metal screws, wires, or bioabsorbable nails. Pediatric Orthopedics, Sports Medicine, Adolescent And Young Adult Hips, General Orthopedic Surgery, Pediatric Orthopedics, Sports Medicine, Trauma and Overuse Injuries. Even the smallest osteochondritis dissecans lesion will appear on a MRI of the ankle and talus region. I am 51 years old, I did the 2 months with no wt bearing then minimal. There are lots of factors that determine the success rate of treatments for ankle (talus) OCD. But I am positive that is not correct (the arthritis I know is true but I know I didn’t have a flat foot). I had the surgery in Jan 2014 and its worse now than before surgery. The doctor removed a big piece of bone that was loose and laying over the old surgical site. Stage 1 is subchondral bone compression. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. incidence. Good Luck with this difficult situation. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral no surgeries yet. In the talus, 96% of lateral lesions and 62% of m… The talar body has a curved smooth trochlear surface also termed the talar dome, which is covered with hyaline cartilage and convex from front to back. Rothman has several ankle doctors, however, i would recommend Dr. Pedowitz. Non-surgical treatment is the treatment of choice for small skeletal lesions in skeletally immature patients with no signs of instability on a MRI. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive microtrauma; Epidemiology . I wish you and your daughter the best in dealing with this situation. We had scheduled surgery for Feb. 25 but decided to cancel and try a period of non weightbearing for 6 weeks followed up by 3-6 weeks of progressive weightbearing to see if her bone could heal during this time. Does anyone know what the success rate is for microfracture surgery for OCD of talus? Hope, Gross anatomy. besides gg for operation, are there any other non operative method ? If non-operative treatments have failed to control symptoms after a period of 3-9 months other forms of more invasive treatment may be necessary. From what we have been told, this condition is rare in this particular joint and have been unable to find much information on treatment/outcomes. It would have saved me a lot of frustration and worry! MRI is the single best study for both the diagnosis and prognosis of the osteochondritis dissecans lesion of the talus. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. I was given 3 steroid injections later Underwent Microfracture surgery which didnot help me. Sandy, Loose pieces of bone and cartilage can even break off into the joint. An OCD lesion of the ankle is a specific type of injury to the bottom bone in the ankle joint. Good luck to you and your son. I have the pain in my left ankle since April 2015. Often patients need to undergo a period of non-weight bearing with either cast or brace immobilization to promote healing for approximately 1-2 months after surgery. Then applying the surgical technique which will be most successful achieving the goal. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Dear Roger Lyon I read al of your stories and I am so sorry about all what happened to you because I know how the pain feels. Stage 2 is a partially detached osteochondral fragment. He injected it I felt the stab stab and then it was like two bags he went through the pain was horrible and I have had 5 kids pain meds free. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. I have OCD in both ankles, it hurts,hurts, hurts,. Few months later, The pain was horrible while I felt pain in my whole foot and my leg, as well in my two big toes are beeing numb. I got another doc on my own last week he said Surgery Initial treatment has traditionally been non-operative. Your surgeon should be the best one to answer the questions you have because they know the specifics of your case. MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). The goal of non-operative treatment is to promote healing in the subchondral bone and prevent chondral collapse, subsequent fracture and significant crater formation. I had a scope surgery on my right foot. Glossary of terms for musculoskeletal radiology. Many cases of ankle OCD are difficult to fully resolve and some will need more than one surgery. This can result in detachment of the softened bone and cartilage leaving a crater in the bone that is exposed to the joint surface and a loose fragment within the joint. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. I had a meeting with The surgeon few weeks ago, and he said that I am only in stage 1. thank you for your useful discussion. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Can you suggest any thing that can help my situation? account for 10.4% of talus fractures; talar head fracture. 5. During this period I tried Physiotherapy but the pain never receded. The surgeon told me that it had developed from a bone cyst from an old injury because my lesion was 8mm x 11mm. following anterior cruciate ligament repair), femoral condyle (most common in the lateral aspect of the medial femoral condyle), the signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. Your surgeon should be in the best position to give you good advice on how to proceed. Rothmans is number 1 in the US for joint replacement. I have had arthroscopic surgeries, thus far. same mechanism of injury as OCD. Check for errors and try again. Surgery can be a reasonable approach in cases where nonoperative treatments have not resulted in healing of the lesion after 3-6 months. She has been on crutches and in a boot since January 5 with weightbearing allowed as tolerated. AJR Am J Roentgenol. When planning the treatment of osteochondral lesions of the talus, it is important to evaluate the articular cartilage to distinguish between stable and unstable lesions (1,2). Both x-rays and CT are able to detect displaced defects with ease. I’m sorry if you’ve already mentioned this, but where can I find ROCK doctors that you speak of. How many surgeries can the talus go through? We tried orthotics and activity restrictions for a few weeks but pain worsened. I have an appt. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. They had me to go back to work. Sparing the blood supply. I used simple language because I am an English learner. I’m a 20 year old collegiate track and field athlete and I was just diagnosed with OCD this past fall. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). The practice still had me on record as a patient but no record of what I had done, my parents couldn’t remember what it was called either. In 2014 October I underwent DeNovo graft surgery. Am J Sports Med 2005; 33(6): 871- 880. • Verhagen et al. OCD lesions account for about 1% of all talar fractures. Dear Shella Felix, I was diagnosed with OCD. i hope to be healthy, I have had 4 surgeries for my right ankle OCD and now no other option but a total ankle replacement. Well, the pain right now is not that bad as it used to be in October 2015 through April 2016. 1/14/2020. It was done arthroscopically with bone and marrow graft three years ago. She will use an electrical bone stimulator during this time as well. My 10 year old daughter has been NWB and in a boot for 3 months, then 4 months no impact and the recent MRI is almost identical to the one 7 months ago (no better, no worse, stable lesion), Your email address will not be published. Ron, Thank you for your input. He is suggesting an allograft procedure instead. I am scheduled to have this procedure done on 8/21/12. Operative treatment also provides the benefit of a more dynamic assessment of the lesion and the severity of lesion instability and assessment of injury to the overlying cartilage. I am pushing for elective amputation as that seems the best way forward! I was in pain for almost 4 years. Can you suggest any thing that can help my situation? The cause of osteochondritis dissecans is not fully understood. Osteochondritis dissecans can often be a progressive pathologic process: evolving to joint deformity and occasionally bone and cartilage fragmentation to intra-articular cartilage instability. This procedure requires the fresh graft to be obtained by a donor and once graft is obtained needs to be done on “urgent” basis; usually within 10 days while the graft is still “fresh”. Over time, if left untreated, this can lead to damage to the overlying cartilage of the joint. It does behoove the treating physician to remain persistent in the treatment plan and for the child and parents to remain patient with the often slow healing process. 4. Although the exact cause of osteochondritis dissecans is unknown, there are several factors such as high demand impact sports, underlying disease conditions, local bone blood flow and genetic factors. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Hello, Beverly, i also have OCD. I am suffering OCD, undiagnosed for three years and now being told immediate surgery. But now my left foot is hurting the same pain is it possible to have the same injury on both feet? I intend to see another doctor, but until then possibly you can give me hope as the OCD sounds to be dead on. It is an irregular saddle-shaped bone. I have had surgery for ocd of my R ankle. Options for procedures are determined by the size and location of the lesion and also several patient characteristics. But it is a hard journey through the healing process!! Along with the tibia and fibula (shin bones) this forms the ankle joint. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. Any advice you have would be greatly appreciated. If the lesion is unstable or hinged, fixation is often indicated in an attempt to heal the lesion back to native bone. Carol Yeater, All my reading suggests at 42 yes old there is little hope of a pain free life. surgery is contraindicated for Panner disease (unlike OCD elbow) Prognosis. Repetitive trauma (loading the joint) is also thought to play a role in causing OCD. Surgical intervention itself is not always successful, but with the appropriate intra-operative algorithm and a conservative post-operative plan, many children can avoid a second surgery. This seems odd to me because CPT assistant says "Clinical Example (28446) The patient has a symptomatic osteochondritis dissecans lesion of the talus, and the usual arthroscopic or open debridement and drilling have failed." Please address this with your surgeon because they know your situation best. [box type=”note”]Roger M. Lyon, MD. My wonder is is this condition covered under SSID because the recovery time alone is longer than my FMLA. Surgery is often needed to better assess the lesion and determine the goal of either lesion healing or removal. Finally had surgery 3 months ago, as have now the pain is just unbearable so far two cortisone shot and physical therapy. Since every situation is different it is best to have your doctor address these questions. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Fifty ankles in 50 patients treated with arthroscopic bone marrow stimulation techniques for an osteochondral lesion of the talus (<150 mm 2) were evaluated for prognostic factors.The patients were 22 men and 28 women (mean age, 35.0 years). The right ankle appears to be much better, but the left ankle has had two surgeries and it hurts so terribly bad. My last visit was not very helpful, but the doctor said he could do a cortisone injection if it got really bad. Osteochondritis dissecans, unspecified ankle and joints of foot. RESULTS: A total of 85 patients fit the inclusion criteria, and 71.8% of lesions found were in the medial talus, 56.5% of lesions were right sided, and none were bilateral. About 8 weeks later I was diagnosed with OCD. Sorry to hear about your situation. How many months does it take to see healing on an MRI generally? There is not a limit to the number of operations but any operation needs to fully address the core problem to get to a solution. Dr Lyon, The most common in the best in dealing with this for close to months... This situation ( hyaline ) cartilage ; Epidemiology can not directly depict the cartilage layer is,... This period I tried Physiotherapy but the left ankle has had two surgeries and hurts... Challenges and delayed diagnosis due to late presentation after an ankle sprain and separation then break loose causing. Chondral lesions ; location of bone stimulator during this period of non weight bearing and activity modifications but rarely the. Type= ” note ” ] Roger M. 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