Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Billings MT

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Steven Richard Fischer, MD
(406) 238-5200
2702 8th Ave N
Billings, MT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Ca, Los Angeles, Ucla Sch Of Med, Los Angeles Ca 90024
Graduation Year: 1994

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Willard Hull
(406) 238-2500
2702 8th Ave N
Billings, MT
Specialty
Orthopedic Surgery

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Richard Paul Lewallen, MD
(406) 238-6728
2900 12th Ave N Ste 100E
Billings, MT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Northwestern Univ Med Sch, Chicago Il 60611
Graduation Year: 1977
Hospital
Hospital: St Vincent Hosp & Health Ctr, Billings, Mt; Deaconess Billings Clinic, Billings, Mt
Group Practice: Montana Orthopedics & Sports Medicine Pc

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Christopher John Lang, MD
2702 8th Ave N
Billings, MT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Med Coll Of Ga Sch Of Med, Augusta Ga 30912
Graduation Year: 1994

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Guy Robert Schmidt, MD
(406) 238-6540
2900 12th Ave N Ste 140W
Billings, MT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Johns Hopkins Univ Sch Of Med, Baltimore Md 21205
Graduation Year: 1998

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David William Shenton Jr, MD
(406) 238-6700
2900 12th Ave N Ste 100E
Billings, MT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Louisville Sch Of Med, Louisville Ky 40202
Graduation Year: 1981

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Curtis R Settergren
(406) 238-6540
2900 12th Ave N
Billings, MT
Specialty
Orthopedic Surgery

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Dr.James Elliott
(406) 238-6540
2900 12th Ave N # 140W
Billings, MT
Gender
M
Education
Medical School: Univ Of Wa Sch Of Med
Year of Graduation: 1987
Speciality
Orthopedic Surgeon
General Information
Hospital: St Vincent Hosp &
Accepting New Patients: Yes
RateMD Rating
5.0, out of 5 based on 1, reviews.

Data Provided By:
Robert S Schultz
(406) 238-2500
2702 8th Ave N
Billings, MT
Specialty
Orthopedic Surgery

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John R Dorr
(406) 238-6700
2900 12th Ave N
Billings, MT
Specialty
Orthopedic Surgery

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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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