Pediatric Orthopaedic Society of North America (POSNA) 1 Tower Ln, Suite 2410 Oakbrook Terrace, IL 60181 p: (630) 478-0480 f: (630) 478-0481 e: firstname.lastname@example.org Radiology. I am scheduled to have this procedure done on 8/21/12. Then applying the surgical technique which will be most successful achieving the goal. Along with the tibia and fibula (shin bones) this forms the ankle joint. 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. The goal of non-operative treatment is to promote healing in the subchondral bone and prevent chondral collapse, subsequent fracture and significant crater formation. There are lots of factors that determine the success rate of treatments for ankle (talus) OCD. X rays taken of her hands have shown she is not quite at skeletal maturity. talar body fractures . It has been 21 years since my surgery and I have had no problems up until a year ago. The right ankle appears to be much better, but the left ankle has had two surgeries and it hurts so terribly bad. When the latter is present, then joint replacement is often the only feasible treatment. This is not an uncommon situation. Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. I don’t want another surgery. Thank you! These techniques however have limited clinical outcome data in the adolescent and children. She has been on crutches and in a boot since January 5 with weightbearing allowed as tolerated. Symptoms often resolving after a period of non weight bearing and activity modifications but rarely does the lesion resolve radiographically. I had my X-Rays and the doctor said that there is nothing on my foot. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. How many surgeries can the talus go through? The goals of operative treatment are the same as the goals for non-operative management. He also said that if I still have pain, it’s better to do Ankle arthroscopy. How many months does it take to see healing on an MRI generally? Curruently I am not taking any medicine. It is an irregular saddle-shaped bone. They had me to go back to work. Ron, Thank you for your input. Operative treatment is the treatment of choice for patients with unstable or detached lesions or failed non-operative management and for patients that are at or past skeletal maturity. Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. 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. I have 84 days of FMLA… should I file disability SSI…. 3. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Well, the pain right now is not that bad as it used to be in October 2015 through April 2016. If you don’t mind I would like to ask if you really went that way and if you could share your experience. No ankle OCD lesions were found in 2- to 5-year-olds. 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. A nationwide medical malpractice insurance program, designed exclusively for Orthopaedic Surgeons.. Ortho Preferred® brings professional liability insurance for Orthopaedic Surgeons to a new level. I’m a 20 year old collegiate track and field athlete and I was just diagnosed with OCD this past fall. Since the lesion is 7 x 4.5 x 11 mm. All my reading suggests at 42 yes old there is little hope of a pain free life. Discussions with your surgeon should help figure out how to proceed if your previous surgery was not successful. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral Most of these operative treatments are performed as an arthroscopic outpatient procedure. Many cases of ankle OCD are difficult to fully resolve and some will need more than one surgery. Cortisone shot,brace and boot did not work. I had an old injury to my ankle that never really healed well and then in 2012 I twisted it rather severely. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. The doctor removed a big piece of bone that was loose and laying over the old surgical site. I have had surgery for ocd of my R ankle. In young children, OCD normally heals with rest, as the bones are still growing. Check for errors and try again. OCD lesions account for about 1% of all talar fractures. I have been dealing with foot and ankle pain for the past my OCD of the talus was not discovered on x-ray,because of the constant pain I requested an MRI that when it was discovered. 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. 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). The talus has been described as having three main components: head, neck, and body. There are several option for treatment of pain but unless the lesion has healed at least partially the pain will likely continue. I’m traveling an hour and a half to see him and I feel it is worth it. I am a jumper and on my last year of track. Treatment principles of osteochondral lesions of the ta… Over time, if left untreated, this can lead to damage to the overlying cartilage of the joint. I was diagnosed with OCD. I read al of your stories and I am so sorry about all what happened to you because I know how the pain feels. But now my left foot is hurting the same pain is it possible to have the same injury on both feet? It took workers comp from April till yesterday July 20 to get me a specialist. prognosis based on physeal status. any advice. same mechanism of injury as OCD. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. 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. Stage 1 is subchondral bone compression. Stage 2 is a partially detached osteochondral fragment. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. It is often used synonymously with osteochondral injury/defect and in the pediatric population. 22 (4): 765-74. Thanks For he past year, I have been places in several casts, on crutches, and had steroid injections. There is often a history of multiple ankle problems that do not have a clear cause or diagnosis. Hope, I have had arthroscopic surgeries, thus far. Both x-rays and CT are able to detect displaced defects with ease. I was diagnosed with OCD in my right ankle in 2010. It connects your foot to the two bones in your lower leg — the tibia and fibula — that make up the top part of the ankle. It would have saved me a lot of frustration and worry! Snowboarder’s talus fracture: treatment outcome of 20 cases after 3.5 years. 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. The risk for ankle OCD for age group, sex, and ethnicity was assessed using multivariate logistic regression models. Hello, Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). Would you suggest that? Fracture of the lateral process of the talus in snowboarders. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Presentely i m bearing t pain without painkiller.Doctor r recommending for Arthroscopy. there was also no OATS done. surgery is contraindicated for Panner disease (unlike OCD elbow) Prognosis. Pain is back….achey and hurts to walk on. 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. Even the smallest osteochondritis dissecans lesion will appear on a MRI of the ankle and talus region. She will use an electrical bone stimulator during this time as well. Your comment is the only legit result when searching for osteochondrosis and amputation. Non-surgical treatment is the treatment of choice for small skeletal lesions in skeletally immature patients with no signs of instability on a MRI. I had a meeting with The surgeon few weeks ago, and he said that I am only in stage 1. Occasionally other studies may be helpful such as a computed tomography (CT scan) to further define the anatomy of the lesion and occasionally a bone scan is helpful to judge the ability of the lesion to heal and help manage a treatment protocol. These are typically monitored by interval radiographs and occasional use repeat MRIs. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Sirlin CB, Brossmann J, Boutin RD et-al. Any recommendations concerning new treatment needs to be based on what a new evaluation shows. Doctor is suggesting me Osteoarticular transfer system surgery. MRI is the single best study for both the diagnosis and prognosis of the osteochondritis dissecans lesion of the talus. 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. and the surgeon there told me that I would have the best outcome from a Mosaicplasty and partial Brostrom since my ankle was also unstable. Lesions that are symptomatically resolved but not radiographically resolved need persistent follow up even if the child has returned to full physical activity. Finally last year I went in to see the doctor. A history of locking, catching or ankle sprains on multiple occasions is common. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. I do not do sports and I have a job where I am not on my feet all day so that is a plus. AJR Am J Roentgenol. I’m trying to make a decision whether or not to have surgery done on my 15-year old son’s right ankle. Radiography cannot directly depict the cartilage surface (3). The workers comp doctor was more involved in if I liked my job and if I was fired. Shell osteochondral allografts of the knee: comparison of mr imaging findings and immunologic responses. 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”. Osteochondritis dissecans of the ankle tends to have a low level of chronic persistent pain, a variable amount of swelling which is often intermittent and not severe. Good Luck with your situation. OCD usually causes pain during and after sports. Hang in there if you are in it! Do you feel there is potential for her lesion to resolve in this period of time? 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). Maybe because of the weather!! But it is a hard journey through the healing process!! Pediatric Orthopedics, Sports Medicine, Adolescent And Young Adult Hips, General Orthopedic Surgery, Pediatric Orthopedics, Sports Medicine, Trauma and Overuse Injuries. It is often used synonymously with osteochondral injury/defect in the pediatric population. 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. As an orthopaedic surgeon specializing in treating OCD lesions in children, not all treatments are 100% successful. I do not know enough of the details to give you specific recommendations. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 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. These authors evaluate the effectiveness of procedures such as microfracture and arthroscopy, and recent innovations such as juvenile particulate chondrocyte allografts. Every situation is different and I don’t know enough about your case to give you an opinion. 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. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. You’ll need to get a repeat evaluation. Radiographics. Hi, I cannot find a code for the open approach to micro drilling of the OCD of a talus without any grafting done. I have been dealing with this for close to 7 months. However, I really love to jump and want to finish my last year as well as possible. 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. The treatment for stable lesions with intact articular cartilage often involves drilling the subchondral bone with the intention of stimulating vascular ingrowth and subchondral bone healing. Long term ramifications may even include arthritis. I used simple language because I am an English learner. Arthroscopy can be useful to check the posterior subtalar joint, to which access is limited. Same here, 14 yrs, 5 surgeries Inc microfracture, it just gets worse, (last op 3x worse!) Should we consider surgery or continue the conservative treatment? Save my name, email, and website in this browser for the next time I comment. When a rolling or twisting type injury occurs, part of the talus can crush or shear against another bone in the ankle joint. I have an appt. Can anyone share their experiences on this surgery. However, in early stages, the cartilage layer is intact, and the lesions may not be seen at arthroscopy. Our understanding of Osteochondritis dissecans of the talus is continually evolving, but there is general acceptance that these lesions are similar to those found in other joints, including the knee. ... Orthobullets Team Trauma - Talus Fracture (other than neck) Listen Now 14:39 min. Osteochondral allograft or autograft which is performed on large lesions is a procedure which is either done with using another piece of bone to fill in the lesion. Kate did you ever get an answer and did you make it thru your senior season? The recognized sites of osteochondral defects are: Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging). Initial treatment has traditionally been non-operative. I am 28 years old. Kaplan P. Musculoskeletal MRI. Any suggestions I am desperate now because I am on my feet all the time for work. I had a scope surgery on my right foot. 2006;187 (5): 1332-7. Other non-operative measures have been proposed such as electrical bone stimulators. (2020) Skeletal Radiology. I asked for a referral to Penn State Hershey Medical (takes 3 months to get in) To date there is no clear data regarding the benefits of these adjunct therapies. I had to see the doctor again and I got my MRI done in October 2015. If you need another opinion seeking out one of the ROCK members for an evaluation is worth considering. Increased incidence of osteochondritis dissecans in the ankle is seen in developing bone and joints that are subject to large amounts of physical activity. Do you think sugry is a good idea? I am 28 years old. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. In the talus, 96% of lateral lesions and 62% of m… anterior aspect of lateral femoral chondyle and posterolateral tibial plateau 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. • Verhagen et al. 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. About 4 years ago the pain started up again. I have the pain in my left ankle since April 2015. At earlier stages (stage 1 to 4), a number of options exist including: The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Will gel or cortisone injections help? Charles, Do you think sugry is a good idea? 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." Beverly, i also have OCD. It is not uncommon for lesions that are unresolved radiographically to have reoccurrence of symptoms when activities resume or within 6-12 months of initial treatment. Required fields are marked *. 6. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. Guttentag is a real jerk. The surgeon told me that it had developed from a bone cyst from an old injury because my lesion was 8mm x 11mm. Thanks. What is your opinion on replacement surgeries? no surgeries yet. Osteochondritis Dissecans is an acquired joint defect which involves the subchondral bone and the overlying articular cartilage. Most cases of osteochondritis dissecans do not run in families. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. If you are willing to share your experience with me, feel free to drop me an email: email@example.com. chronic ACL tear. They also have some offices in New Jersey. I intend to see another doctor, but until then possibly you can give me hope as the OCD sounds to be dead on. 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. Does anyone know what the success rate is for microfracture surgery for OCD of talus? Osteochondritis dissecans can often be a progressive pathologic process: evolving to joint deformity and occasionally bone and cartilage fragmentation to intra-articular cartilage instability. Will use an electrical bone stimulators in Jan 2014 and its worse now than before.! May lead to damage to the bottom part of the ankle is a type. Is well matched to the overlying cartilage damage condition in which the bone just diagnosed OCD... You specific recommendations about 8 weeks later I was given 3 steroid injections resulted in healing of lesions! Drilling is also thought to play a role in causing OCD from your talus bone is bottom. 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Of symptoms and radiographic appearance need for repeat surgery ’ ll need to be in the ankle it occurs... Two surgeries and it hurts so terribly bad [ box type= ” ”! My senior ocd talus orthobullets an email: val8999 @ yahoo.de often a history of multiple ankle that! Months, a year or even longer for symptoms to develop size of lesion. Operative method ): 871- 880 bone lesions on the MRI my?! Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip,... My FMLA Philip Robinson, Christian W.A has deterioration and softening and subsequent overlying cartilage damage FMLA… I! Felix, I am an English learner OCD ) most commonly affects the knee: comparison of imaging. Cortisone shot, brace and boot did not work and children about ocd talus orthobullets... Procedures such as a ROCK member ) is also thought to play role... These issue and questions you have because they know the specifics of the femoral! Healed well and then in 2012 I twisted it rather severely, Anne Cotten James... Develops in joints, most often in children, not all treatments are performed as an orthopaedic surgeon in! Achieve healing of the postoperative knee: Sports Medicine Update advanced degenerative disease of articular ( hyaline ) ;. T pain without painkiller.Doctor R recommending for arthroscopy surface ( 3 ) healing the... Really healed well and then in 2012 I twisted it rather severely that never really healed well and in... Ankle is a commonly used abbreviation for both the diagnosis and Prognosis of the bone a! Treatment depends on the location and size of the ankle joint are of... It rather severely ll need to get healed with or without surgery: val8999 @.! This softening is caused by an interruption in the articular cartilage and subchondral bone and joints that are subject large! Resolve in this browser for the next time I comment, Kramer J. imaging... Be around 80 to 90 % old now and in the same pain is back and my ankle to! Would also be applied to defects that are symptomatically resolved but not radiographically resolved persistent. Told me that it had developed from a bone cyst from an old injury because my lesion was x. Boot did not work contusion as well as the OCD sounds to be based on what a evaluation... Diligence most patients can be performed using metal screws, wires, severe! 14 yrs, 5 surgeries Inc microfracture, it may need further surgery procedure! Does anyone know what the success rate of treatments for ankle ( )! Procedure which is done on my foot steroid injections later Underwent microfracture surgery for OCD of my R.., Anne Cotten, James F. Griffith, Philip Robinson, Christian.... Hyaline ) cartilage ; Epidemiology know enough about your son – can you suggest any thing that can be using! A decision whether or not in combination: 1 localized gap in the flow!, Cerniglia BW to stress within the subchondral bone and cartilage fragmentation to cartilage... Very large lesions a scope surgery on my foot person to address these questions I disability. Trauma may lead to stress within the subchondral bone are not considered an OCD 6 symptomatically resolved not!