Arthroscopic Diagnosis and Treatment of Osteochondral Talar Lesions Peru IN

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William Hugo Pohnert, MD
(765) 472-8041
285 W 12th St Ste 106
Peru, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Mi Med Sch, Ann Arbor Mi 48109
Graduation Year: 1967
Hospital
Hospital: Howard Comm Hosp, Kokomo, In; St Joseph Mem Hosp, Kokomo, In; Dukes Mem Hosp, Peru, In; Healthsouth Rehabilitation Hos, Kokomo, In
Group Practice: Northcentral Indiana Ortho

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Charles Edward Montgomery, MD
(574) 753-4193
1601 Chase Rd
Logansport, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: In Univ Sch Of Med, Indianapolis In 46202
Graduation Year: 1969

Data Provided By:
Jesse Lee Sandlin, MD
(574) 753-4193
1601 Chase Rd
Logansport, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Northeastern Oh Univs Coll Of Med, Rootstown Oh 44272
Graduation Year: 1994

Data Provided By:
Jeffrey Francis Granger, MD
(574) 753-4193
1601 Chase Rd
Logansport, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Chicago, Pritzker Sch Of Med, Chicago Il 60637
Graduation Year: 1981

Data Provided By:
Jeffrey Dean Yoder, MD
(765) 868-0313
Medical Office Bldg 200 1907 W Sycamore St
Kokomo, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: In Univ Sch Of Med, Indianapolis In 46202
Graduation Year: 1994

Data Provided By:
Aijaz Mohammed Mirza, MD
(260) 569-2408
710 N East St
Wabash, IN
Specialties
Orthopedics
Gender
Male
Education
Medical School: Dow Med Coll, Univ Of Karachi, Karachi, Pakistan
Graduation Year: 1958
Hospital
Hospital: Wabash County Hosp, Wabash, In
Group Practice: Mirza Orthopedics

Data Provided By:
Charles E Montgomery
(574) 753-4193
1601 Chase Rd
Logansport, IN
Specialty
Orthopedic Surgery

Data Provided By:
Jeffrey F Granger
(574) 753-4193
1601 Chase Rd
Logansport, IN
Specialty
Orthopedic Surgery

Data Provided By:
Jeffrey Dean Yoder
(765) 868-0313
1907 W Sycamore St
Kokomo, IN
Specialty
Orthopedic Surgery

Data Provided By:
Thomas M Reilly
(765) 236-8700
311 S Berkley Rd
Kokomo, IN
Specialty
Orthopaedic Surgery of the Spine

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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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