Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Hockessin DE

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David T Sowa, MD
(302) 731-2888
4745 Ogletown Stanton Rd
Newark, DE
Business
First State Orthopaedics PA
Specialties
Orthopedics

Data Provided By:
Christopher D Casscells, MD
(302) 832-6222
3505 Silverside Rd Ste 100 Plaza Center
Wilmington, DE
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Va Sch Of Med, Charlottesville Va 22908
Graduation Year: 1981
Hospital
Hospital: St Francis Hosp, Wilmington, De; Christiana Care -Wilmington, Wilmington, De
Group Practice: Casscells & Assoc

Data Provided By:
Paul Kupcha, MD
(302) 633-3555
1941 Limestone Rd Ste 101
Wilmington, DE
Specialties
Orthopedics
Gender
Male
Education
Medical School: Georgetown Univ Sch Of Med, Washington Dc 20007
Graduation Year: 1986
Hospital
Hospital: Christiana Care -Wilmington, Wilmington, De; Christiana Hosp, Newark, De
Group Practice: Delaware Orthopaedic Ctr

Data Provided By:
Damian M Andrisani
(302) 633-3555
1941 Limestone Road
Wilmington, DE
Specialty
Orthopedic Surgery

Data Provided By:
Brian J Galinat
(302) 633-3555
1941 Limestone Road
Wilmington, DE
Specialty
Orthopedic Surgery

Data Provided By:
John Richard Smoluk, MD
PO Box 550
Hockessin, DE
Specialties
Orthopedics
Gender
Male
Education
Medical School: Temple Univ Sch Of Med, Philadelphia Pa 19140
Graduation Year: 1968

Data Provided By:
Peter F Townsend
(302) 633-3555
1941 Limestone Rd
Wilmington, DE
Specialty
Orthopedic Surgery

Data Provided By:
Dr.Paul Kupcha
(302) 633-3555
1941 Limestone Rd # 204
Wilmington, DE
Gender
M
Education
Medical School: Georgetown Univ Sch Of Med
Year of Graduation: 1986
Speciality
Orthopedic Surgeon
General Information
Hospital: Christiana Care -Wilmington, Wilmington, De
Accepting New Patients: Yes
RateMD Rating
3.4, out of 5 based on 6, reviews.

Data Provided By:
David Axon
(302) 993-2453
4512 Kirkwood Hwy
Wilmington, DE
Specialty
Orthopedic Surgery, Adult Reconstructive Orthopaedic Surgery

Data Provided By:
Steven Michael Dellose, MD
(302) 633-3555
1941 Limestone Rd Ste 101
Wilmington, DE
Specialties
Orthopedics
Gender
Male
Education
Medical School: Jefferson Med Coll-Thos Jefferson Univ, Philadelphia Pa 19107
Graduation Year: 1996
Hospital
Hospital: Riverside Health Care Center, Wilmington, De
Group Practice: Delaware Orthopeadic Ctr

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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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