Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Davison MI

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Gordon Neil Holen, DO
Davison, MI
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Orthopedics
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Male
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Medical School: Mi State Univ, Coll Of Osteo Med, East Lansing Mi 48824
Graduation Year: 1998

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John J L Yap, MD
(810) 667-6110
PO Box 264
Hadley, MI
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Orthopedics
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Graduation Year: 2007

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Michael John Picco
(810) 606-5000
1 Genesys Pkwy
Grand Blanc, MI
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Orthopedic Surgery

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John D Martin, DO
(989) 723-5136
861 Health Park Blvd
Grand Blanc, MI
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Orthopedics
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Male
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Medical School: Mi State Univ, Coll Of Osteo Med, East Lansing Mi 48824
Graduation Year: 1982

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Michael Joel Sorscher, MD
(810) 606-6990
4442 Genesys Pkwy
Grand Blanc, MI
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Orthopedics
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Male
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Medical School: Wayne State Univ Sch Of Med, Detroit Mi 48201
Graduation Year: 1987

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Dr.Ishwar Dass
George Hamo \x26 Associates, 142 West Second Street, Suite 101
Flint, MI
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Orthopedic Surgeon
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Hospital: McLaren
Accepting New Patients: Yes
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Brian Kieth Rill, MD
(810) 342-2111
Grand Blanc, MI
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Orthopedics
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Male
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Medical School: Wayne State Univ Sch Of Med, Detroit Mi 48201
Graduation Year: 2001

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Mark Edward Dyball
(810) 953-0500
861 Health Park Blvd
Grand Blanc, MI
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Orthopedic Surgery

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John G De Santis, DO
(810) 664-3721
1245 N Main St
Lapeer, MI
Specialties
Orthopedics
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Male
Education
Medical School: Mi State Univ, Coll Of Osteo Med, East Lansing Mi 48824
Graduation Year: 1980

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Francesca Marina Swartz
(810) 606-5000
1 Genesys Pkwy
Grand Blanc, MI
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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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