Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Burlington VT

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James Gregory Howe, MD
95 Carrigan Dr Fl 4
Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Vt Coll Of Med, Burlington Vt 05405
Graduation Year: 1973

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Claude Elmer Nichols, MD
95 Carrigan Dr Fl 4
Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Temple Univ Sch Of Med, Philadelphia Pa 19140
Graduation Year: 1979

Data Provided By:
John C Macy
(802) 862-3983
6 San Remo Dr
South Burlington, VT
Specialty
Orthopedic Surgery

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Andrew Stone Kaplan, MD
6 San Remo Dr
South Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Columbia Univ Coll Of Physicians And Surgeons, New York Ny 10032
Graduation Year: 1987

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Dr.James Mogan
(802) 658-0714
43 Timber Lane
South Burlington, VT
Gender
M
Education
Medical School: Univ Of Vt Coll Of Med
Year of Graduation: 1972
Speciality
Orthopedic Surgeon
General Information
Accepting New Patients: Yes
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3.6, out of 5 based on 5, reviews.

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Martin Hans Krag, MD
(802) 656-4472
95 Carrigan Dr Fl 4
Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Yale Univ Sch Of Med, New Haven Ct 06510
Graduation Year: 1975
Hospital
Hospital: Fletcher Allen Health Care, Burlington, Vt

Data Provided By:
Tucker Andrew Drury
(802) 656-3806
95 Carrigan Dr
Burlington, VT
Specialty
Orthopedic Surgery

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Michel Y Benoit, MD
(802) 847-4690
1 S Prospect St
Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ De Montreal, Fac De Med, Montreal, Que, Canada
Graduation Year: 1985

Data Provided By:
Robert Jonathan Johnson, MD
1 S Prospect St
Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Ia Coll Of Med, Iowa City Ia 52242
Graduation Year: 1964

Data Provided By:
John F Lawlis III, MD
(802) 862-3983
6 San Remo Dr Ste 101
South Burlington, VT
Specialties
Orthopedics
Gender
Male
Education
Medical School: Jefferson Med Coll-Thos Jefferson Univ, Philadelphia Pa 19107
Graduation Year: 1982

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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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