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Osteochondritis Dissecans

Posted by Louise on 6/27/01 at 09:12 (051624)

Hello
I have finally been diagnosed as having Osteochondritis Dissecans. It is on top of the Talus. My doctor advised surgery because he feels that if the bit of bone moves around my foot it will cause further pain / damage. I am confused about a couple of things though...

1) I have read on various internet sites that surgery does not necessarily cure the problem. Is this so? ie is surgery the best option?

2) I have also read that I will almost certainly get osteoarthritis if I have surgery (Arthoscopy). Will I get it if I don't have surgery?

3) I am confused as to the recovery time...how long will I have to have off work / how long will I be on crutches / will I make a full recovery (to include skiing). The doctor said they need to remove about a quarter of the bone... what happens if it decays further - do I have to have an ankle replacement? (I am only 27 now...)

I'd appreciate replies from the Doctors and from patients who have had this surgery. Thank you for listening!
Louise

Re: Osteochondritis Dissecans

Donna SL on 6/27/01 at 10:44 (051627)

Louise,

Three years ago I was diagnosed with a talor dome injury. Some doctors said it was osteochondritis dissecans, because there was no injuy that I can recall when I got it. This was confirmed on an MRI, but there were no loose bodies floating around. The first doctor wanted to do surgery immediately, and said it wouldn't heal with out it. I got a second opinion, and the second orthopedic surgeon said leave it alone, and it will heal. I'm glad I listened to him. I had a recent MRI in Dec. and it showed that it is almost healed. I have not had any painful symptoms for almost 2 years now.

The traditional surgery that is available for this can sometimes make it worse. They ususally drill some extra holes in the bone to get it to heal, but sometimes the hole doesn't heal, and gets worse. Unless the lesion is hugh, I've never heard of such a large amount of bone being removed.

There's a newer surgery called mosaic (sp?) surgery that is being used for osteochondritis of the knee, that is suppossed to be very successful, but I'm not sure if it's been done on the ankle yet. I read about it years ago, so they are probably doing for ankles now.

If the pain isn't totally crippling give it time, and it might get better. Take powerful anti-inflammatories if you can. I had a lot of locking type pain at times, pain on wt bearing, etc., but it went away as it healed.

If you really need surgery, or if there are any loose bodies around, then see if there are any foot and ankle surgeons doing mosaic surgery on the ankle. This has a much higher success rate. Otherwise wait. You might have to search for this type a surgeon at a University hospital.

I never thought my ankle would heal, but I'm glad I listened to the second surgeon. Also, I owe some credit to my pod who also talked me out of the surgery, and explained the complications with the existing methods.

I had some pain on and off for a year, before it healed,and then after that intermittant pain. Now I have none. So, if you've just been diagnosed with it give it a chance to heal on it's own. Also if you wear rigid orthotics, or ones with a lot of control, try to switch to a less controlling orthotic while this is healing, because you don't want too much pressure pushing on the talar dome.

Also, if you just got this, then casting for 6 weeks can help, but only if this just occurred. Otherwise you are better not casting it, because it can actually hinder healing.

I would definitely get a second opinion from a top notch foot and ankle surgeon who is up to the minute on this new technique. Again if you had an MRI, and the lesion is small, and there are no loose bodies, it will probably heal.

Donna

Re: Osteochondritis Dissecans

Louise on 6/29/01 at 03:10 (051829)

Thanks for your advice Donna. I think there is a loose bit of bone there and because I have had foot pain for 4-5 years (it's been misdiagnosed twice) the loose bone is dead (shows up black on an MRI). I don't think there is any chance of reattachment. Also, where the bone has broken away, there is a lot of arthritis and I believe some necrosis.

I think I will end up having to have surgery, which annoys me because the pain is only intermittent. But the doctor I saw believes that if this bit of bone goes travelling round my foot, it could cause serious damage.

I have been reading about mosaicplasty on the internet and it appears to be more successful than traditional surgery.

Does anyone out there know how I can locate a GOOD foot and ankle orthopaedic surgeon in Britain? I would even be prepared to travel abroad for surgery if I thought that was the only option (but obviously it's not ideal to try to recouperate in a strange hotel room and it's going to work out really expensive that way as my insurance won't cover it).

Any ideas anyone?

Re: Osteochondritis Dissecans

Donna SL on 6/27/01 at 10:44 (051627)

Louise,

Three years ago I was diagnosed with a talor dome injury. Some doctors said it was osteochondritis dissecans, because there was no injuy that I can recall when I got it. This was confirmed on an MRI, but there were no loose bodies floating around. The first doctor wanted to do surgery immediately, and said it wouldn't heal with out it. I got a second opinion, and the second orthopedic surgeon said leave it alone, and it will heal. I'm glad I listened to him. I had a recent MRI in Dec. and it showed that it is almost healed. I have not had any painful symptoms for almost 2 years now.

The traditional surgery that is available for this can sometimes make it worse. They ususally drill some extra holes in the bone to get it to heal, but sometimes the hole doesn't heal, and gets worse. Unless the lesion is hugh, I've never heard of such a large amount of bone being removed.

There's a newer surgery called mosaic (sp?) surgery that is being used for osteochondritis of the knee, that is suppossed to be very successful, but I'm not sure if it's been done on the ankle yet. I read about it years ago, so they are probably doing for ankles now.

If the pain isn't totally crippling give it time, and it might get better. Take powerful anti-inflammatories if you can. I had a lot of locking type pain at times, pain on wt bearing, etc., but it went away as it healed.

If you really need surgery, or if there are any loose bodies around, then see if there are any foot and ankle surgeons doing mosaic surgery on the ankle. This has a much higher success rate. Otherwise wait. You might have to search for this type a surgeon at a University hospital.

I never thought my ankle would heal, but I'm glad I listened to the second surgeon. Also, I owe some credit to my pod who also talked me out of the surgery, and explained the complications with the existing methods.

I had some pain on and off for a year, before it healed,and then after that intermittant pain. Now I have none. So, if you've just been diagnosed with it give it a chance to heal on it's own. Also if you wear rigid orthotics, or ones with a lot of control, try to switch to a less controlling orthotic while this is healing, because you don't want too much pressure pushing on the talar dome.

Also, if you just got this, then casting for 6 weeks can help, but only if this just occurred. Otherwise you are better not casting it, because it can actually hinder healing.

I would definitely get a second opinion from a top notch foot and ankle surgeon who is up to the minute on this new technique. Again if you had an MRI, and the lesion is small, and there are no loose bodies, it will probably heal.

Donna

Re: Osteochondritis Dissecans

Louise on 6/29/01 at 03:10 (051829)

Thanks for your advice Donna. I think there is a loose bit of bone there and because I have had foot pain for 4-5 years (it's been misdiagnosed twice) the loose bone is dead (shows up black on an MRI). I don't think there is any chance of reattachment. Also, where the bone has broken away, there is a lot of arthritis and I believe some necrosis.

I think I will end up having to have surgery, which annoys me because the pain is only intermittent. But the doctor I saw believes that if this bit of bone goes travelling round my foot, it could cause serious damage.

I have been reading about mosaicplasty on the internet and it appears to be more successful than traditional surgery.

Does anyone out there know how I can locate a GOOD foot and ankle orthopaedic surgeon in Britain? I would even be prepared to travel abroad for surgery if I thought that was the only option (but obviously it's not ideal to try to recouperate in a strange hotel room and it's going to work out really expensive that way as my insurance won't cover it).

Any ideas anyone?