Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Aberdeen SD

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James Brian MacDougall
(605) 226-2663
701 8th Ave Nw
Aberdeen, SD
Specialty
Orthopedic Surgery

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Matthew Carl Reynen, MD
(605) 226-2663
701 8th Ave NW
Aberdeen, SD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Sd Sch Of Med, Vermillion Sd, 57069
Graduation Year: 1991
Hospital
Hospital: Huron Reg Med Ctr, Huron, Sd
Group Practice: Orthopedic Surgery Specialists

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Chester Wilson P Mayo, MD
(605) 226-2663
701 8th Ave NW
Aberdeen, SD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Mn Med Sch-Minneapolis, Minneapolis Mn 55455
Graduation Year: 1986
Hospital
Hospital: Huron Reg Med Ctr, Huron, Sd; St Lukes Midland Reg Med Ctr, Aberdeen, Sd
Group Practice: Orthopedic Surgery Specialists

Data Provided By:
James Keith Mantone, MD
(605) 226-2663
701 8th Ave NW Ste A
Aberdeen, SD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Suny At Buffalo Sch Of Med & Biomedical Sci, Buffalo Ny 14214
Graduation Year: 1993

Data Provided By:
Thomas G Harbert
(605) 229-0205
201 S Lloyd St
Aberdeen, SD
Specialty
Orthopedic Surgery

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John Joseph Gluscic, MD
(605) 226-2663
701 8th Ave NW
Aberdeen, SD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Pa Sch Of Med, Philadelphia Pa 19104
Graduation Year: 1986

Data Provided By:
James Brian Mac Dougall, MD
(605) 226-2663
701 8th Ave NW
Aberdeen, SD
Specialties
Orthopedics
Gender
Male
Education
Medical School: Oh State Univ Coll Of Med, Columbus Oh 43210
Graduation Year: 1985

Data Provided By:
Peter R Carter, MD
(214) 559-7572
1440 15th Ave NW
Aberdeen, SD
Specialties
Orthopedics, Hand Surgery
Gender
Male
Education
Medical School: Univ Of Nm Sch Of Med, Albuquerque Nm 87131
Graduation Year: 1968
Hospital
Hospital: Texas Scottish Rite Hospital F, Dallas, Tx

Data Provided By:
James K Mantone
(605) 226-2663
701 8th Ave Nw
Aberdeen, SD
Specialty
Orthopedic Surgery

Data Provided By:
H Ray Duncan, DDS
(605) 225-5761
2319 6th Ave SE
Aberdeen, SD
Specialties
Orthodontics/Dentofacial Orthopedics

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Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions

Persistent ankle pain after an ankle sprain could be a sign of a condition called osteochondral lesion of the talus (OLT). The talus is a bone in the ankle between the calcaneus (heel bone) below and the tibia (shin bone) above.

The bottom of the tibia forms a dome over the top of the talus. With OLT, a piece of cartilage from the talus gets pinched by this dome. In more severe cases, a fragment of cartilage breaks off the talus but stays wedged in place. In the worst cases, the fragment is floating free in the joint space.

Other terms used to describe OLT include osteochondritis dissecans, transchondral fracture, talar dome fracture, and flake fracture. The condition is fairly uncommon. It is difficult to diagnose using X-rays, MRIs, or CT scans.

The authors of this study used arthroscopy to diagnose and treat OLT. They graded the condition based on severity as Grade I (mild) through Grade IV (severe). Treatment results were compared to see if outcomes were better for milder forms of the condition. Results showed that arthroscopic grading of OLT does predict final outcome after surgery. This is something that cannot be accomplished with X-rays or other more advanced forms of imaging.

Milder lesions without fragmentation had better results. Patients were more likely to have a good-to-excellent outcome without complications if the cartilage was not torn away. They were not able to compare results based on specific surgery done because there were too many different kinds of operations performed.

For example, some patients had holes drilled in the talus where the fragment had broken off. This procedure is called microfracture. It stimulates new growth of fibrocartilage. Other patients had the loose piece of cartilage removed (excision) with smoothing of the bone where the piece was broken off. And some patients had both excision and drilling.

Almost three-fourths of the group had good-to-excellent results. Most were able to return to all preoperative levels of activity. A few patients had complications such as plantar fasciitis, nerve pain or injury, or pain around the puncture wounds where the arthroscope entered through the skin. These problems all disappeared during the first six months of recovery.

Results of treatment did not appear to be linked with age, gender, or the side affected (right or left ankle). Delays between injury and surgery did not seem to make any difference in the final results. Worker's compensation patients did have poorer results compared with those who were not on worker's comp.

Follow-up was for at least five years. So it was possible to see if the long-term results changed over time. They found that more than one-third of the patients had a deterioration of their good results over time. Deep aching and pain with swelling recurred. Limited motion and instability occurred with degeneration of the joint. The reason(s) for this change was unknown.

The authors were unable to provi...

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