Messages

1

OCD Surgeries / Re: Microfracture and OATS Updates

« on: November 11, 2018, 10:55:40 AM »

Lets Do This, 

Really glad to hear that your surgery went well!!  Thanks for all the great information you posted!  It is all really helpful, including the Dr. and insurance info. A few years ago, I contacted Dr. Schon to see if I could see him during a trip I had to DC and found a similarly long lead time for appointments.   Good luck with your recovery and please keep us posted on how it is going!! 

2

Ankle / Re: Ankle OCD – new diagnosis

« on: November 11, 2018, 10:31:03 AM »

Paul, 

Really glad to to hear your got the screws out!!  It sounds like you are feeling pretty good following that -- is it continuing to feel better?  You may have said before, but was the surgeon’s original plan to leave the screws in or optional for removal?

Thanks for your thoughts about the microfracture option for me.  That is really helpful information to know that you had a good MF outcome and were very active post-MF surgery (I would love to be able to do long trail runs again!).  Your comments about addressing the other issues is very interesting as one of the Drs. I saw (and one of my MRI reports) mentioned a potentially torn (or partially torn) peroneus longus tendon, but others noted that can appear falsely on the MRI.  In all the “stability tests” I have been given by various Drs., they have always said my ankle was very stable.

I have wondered if I am costing myself a chance at being closer to 100% (and being able to run a lot again) because I am afraid to take the surgery plunge.  I guess one piece evidence that has affected me was from Dr. Ferkel, who recommended MF, but not running afterward.  With the exception of running, I can do almost everything I want to do outdoor activity-wise. The biggest thing for me right now is to get the extra weight off.  I wouldn’t want to head into surgery, having not first gotten my weight down to evaluate the impact of that on my ankle.

Thanks for all your posts with so much good info and best of luck on your continued recovery!!
Please keep us posted on how your recovery going.

Steve

3

Ankle / Re: Ankle OCD – new diagnosis

« on: October 30, 2018, 12:52:42 PM »

Hi Lets Do This,

Thanks for your post and all the good info on OATS and best of luck on your surgery and recovery!!!  We will all be thinking of you!
Your reasoning makes really good sense to me -- with all the other factors and the 2-plug v. 3 plug seems like a big issue (I definitely did not know about that multiple plug aspect of OATS).  So much to learn abut OATS (and all these different treatments). 

Thanks for you thoughts and info on my situation and MF.  It is interesting that with a couple of exceptions, MF is all that has been recommended to me (even by ankle surgeons that do other techniques).  I guess I should be (and am) grateful that that means that my OCD is small/minor, but I am not eager to do MF, as is seems like it is doomed to eventually fail / lead to another surgery (I don't have proof of that, but sure seems that way). 

Again,  best of luck with the surgery and let us know how it goes!!

4

Ankle / Re: Ankle OCD – new diagnosis

« on: October 29, 2018, 10:11:33 PM »

Here is an update on my ankle OCD and some thoughts and questions on recent posts.

I am a little over 5 years past an Aug. 2013 ankle sprain that caused my minor OCD injury (talus apparently hit the tip of fibula causing “kissing lesions” with 3 x 8 lesion on lateral talar dome and a prominent cyst in the fibula).  I got several opinions from ankle surgeons over the first 2.5 years (mixed on surgery recommendation, most suggesting microfracture or doing nothing).  I have had 2 MRIs, (Dec 2013, April 2016) with little change between them.  I did a fair bit of PT from years 2-4, but no ankle PT for past year. I am still not ready to consider surgery as I think it is quite likely I would be worse off after surgery.

I am continuing to have only minor pain / impact from day-to-day activity and I can do a lot of activities including hiking with only minimal discomfort.  I have been running a bit (1-2 miles every other week or so, very occasionally a 5 mi. run), and this produces what is now a pretty predictable outcome (no pain during the run, then fairly minor pain beginning by the next day and continuing through a 3-5 day cycle of peaking, then gradually settling down).  A couple of months ago, I got worse and longer lasting pain after a couple week period of a lot of activity (running, a lot of cycling, some backpacking with a minor ankle twist).  That scared me and it took three weeks of really backing off activity for the ankle to settle back down.   Overall, I think I have more consistent minor pain in my ankle now than I did a year ago.

Unfortunately, my weight has continued to go up in the past couple of years, which of course makes the ankle impact from running (and other activities) worse.  I only run on soft surfaces wearing Hokas, never run hard downhill, and almost always ice my ankle after running.  Regardless, continuing to run, despite not losing weight, is likely a risky choice.  As an example of the difference between walking and running: I did an 11 mi. hike on easy level surfaces a couple of weeks ago with virtually no ankle pain afterward,  then I did a 3 mi. run / walk last week (ran about half of it) and got the usual minor pain on the side of my ankle.  I guess I really do need to let the running go completely (at least until I get my weight down), if I want to avoid eventual surgery! 

Lets Do This: 
I have followed your posts and while I hesitate to offer an opinion (your situation is very different from mine -- bigger more serious lesion, previous surgery), I have a thought, if you are still on the fence.  Basically, if you are having no (or only very minor) symptoms, I would weigh carefully the potential downsides (including the possibility that you might be worse off after surgery) before committing to having another surgery right now.  Surgery involves lots of different risks -- including no guarantee of success, long difficult recovery (independent of the degree of surgery success), and scar tissue and other aspects that often seem to degrade the ankle with each surgery.  If things are pretty good right now, it might not be worth those risks.  Good luck!!

Questions to all:
-- Does OATS always involve the osteotomy (cutting of the malleolus) to access the site for the plug implant and the use of screws for the malleolus healing?  PDS -- thanks for your really informative posts and good luck with the “metal” issues you are having! 
-- OATS also always involves harvest of the plug from somewhere else (usually knee?)?  Also could someone explain the allograft vs. autograft for lesions > 2 cm that someone referenced?  Is it not possible to auto-harvest a large enough plug? If not, what is the source of the plug?

Thanks to everyone for all the great info and best of luck in healing / managing your ankles!!

5

The Waiting Room / Re: A different kind of orthopedic surgery

« on: December 11, 2017, 02:35:00 AM »

Hi Frank – thanks for your post.  My hamstring recovery is going well.  I am 4.5 mos. (19 weeks) past surgery and have seen pretty steady week-to-week improvement.  I transitioned off the crutches in weeks 6-8 post-surgery, and have been going for progressively longer walks since then (up to 5-6 mi.), cycling  for about the past 4 weeks , and jogging just a bit in the past couple of weeks.

I sometimes have minor pain at the attachment point from prolonged sitting, but not too much pain overall.  I have also had some pain in my hip joint, but gotten some good help from PT for that.  I tried a steep hike over Thanksgiving and ended up bailing, and could tell I still have some more strengthening to do of the hamstring muscles.  Overall though, it has come along really well and I can picture being back close to full strength by spring.

My OCD ankle seems to have not been strongly affected by the hamstring injury and recovery (as the Dr. and PT said would be the case), but as I have stepped up the long walks and added a bit of running, it still feels like the OCD injury is there (no surprise).  Basically, I don’t notice it during the activity, but the next morning, will notice that the OCD ankle is a little sore, especially if I flex the joint around.  It is quite minor and not stopping activities for now -- I’ll have to see how it evolves as I start to run a bit more.

Frank – I did not see a post from you with any details on your condition.  Have you had surgery?  I am not sure I have much advice.  I guess that NiteOwl and I are two of the longer lasting “conservative treatment” people on this forum (for me, presumably due to a more minor OCD injury and significantly reduced running after the injury).  From various posts on the forum, DeNovo and BMAC / Biocartilage seem like the treatments of choice.  I don’t plan any surgery until my pain gets significantly worse.  Good luck!

Alan – really glad to hear that you are able to do the sport you love at least on occasion!  Does your ankle typically settle back down with a few / several days of rest?

Mhop – it was great to see your post and know that you are able to run a least some!!  Your post is very encouraging!

Cshires – really glad to hear that your ankle is feeling better!  PT and other rehab is so important and underappreciated I think!

6

The Waiting Room / Re: A different kind of orthopedic surgery

« on: September 05, 2017, 12:09:32 AM »

Hi Alan,  Thanks for your good thoughts.  I don’t think my OCD ankle had anything to do with the waterski accident.  The problem was using a slalom ski with a lace-up front boot (it also had an open-heel back boot), which prevented my front foot from releasing when I got yanked forward while kicking off the other ski.  I don't think my ankle had anything to do with the fall and if I had been using a slalom ski with simple toe and heel rubber cups for the front boot I think I would have been fine (I would have still fallen, but my front foot would have just come out of the boot). 

I have been wondering what the hamstring injury will do to my ankle OCD.  The docs say it won't do anything, but my ankle seems a little more sore in general.  Hopefully everything will settle down once I get the PT going and start walking again.

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Ankle / Re: Post surgery journal: MF/BMAC/Biocartilage for OCDs in right ankle

« on: September 03, 2017, 03:27:49 PM »

Hi Christina, Sorry to hear about your recovery and your other ankle.  Glad you have found some other activities, but understand your missing hiking.  Your ExoSym link was really interesting.  It is nice to know that there are additional options!  Good luck!

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Ankle / Re: Debridement, Biocartilage + BMAC at HSS

« on: September 03, 2017, 02:33:27 PM »

Hi Kerri, Glad to hear that your left ankle is almost back to normal!  That is great news!  I am really sorry to hear about your right ankle – hope the surgery goes well if you go that route.  FWIW,  I have had similar experiences with orthotics – but maybe I have not taken enough time to get comfortable with them.

9

The Waiting Room / A different kind of orthopedic surgery

« on: September 03, 2017, 02:18:43 PM »

It has been a little over four years since my OCD injury and I was continuing to go without surgery for it and mostly pain free from it (even running a bit), but all my ankle OCD thoughts went out the window in early July when I severely tore my proximal hamstring tendons while waterskiing (the same leg as the one with the ankle OCD).  I am now nearly six weeks post-surgery to re-attach all three hamstring tendons (conjoined biceps femoris and semitendonosus – retracted 4 cm, and semimembranosus) to the ischial tuberosity (“sit” bone) and in the early stages of a lengthy recovery / rehab.   

While this post is off-topic from ankle OCDs and a bit long, I thought I would share it as many of the things I learned from my ankle OCD research (MRIs, surgeon shopping, etc.) were very helpful for this injury, even though this injury is the opposite of ankle OCDs in a couple of key ways:  1) it is very important to have this surgery done as soon after the injury as possible and 2) there is a good potential for near 100% recovery with this injury. 

The injury happened in early July on vacation in MI, while I was kicking a waterski to slalom. I suffered a severe forward hyperextension of my left (forward) foot.  I don’t remember feeling the pop of the tendons tearing off the ischium, but knew immediately something very violent had happened to my leg.  The first sensation I remember was my leg going completely numb below the knee for about 30 seconds (the sciatic nerve is pretty close to the tendons), then the numbness relaxing, but extreme pain and I could barely walk or sit afterwards.

I went to ER right away and they said it was a bad hamstring strain, but would be better in 7-10 days.  They sent me home with some pain killers and crutches and said I might want to follow up with an orthopedic doctor.  I started do web research right away and hit upon torn proximal tendons as something that might have happened.  I saw a DO in MI two days later and he said I very likely at least partially tore the tendons and ordered an X-ray (negative for a bone avulsion -- more common in young adults), and an MRI.  I pushed and got the MRI in MI the day before we left for home, as my web research indicated that it was important to get surgery as soon as possible (2-4 weeks) before the tendons “scar in” too much in the retracted location.  I also started researching OS’s for this condition in the Denver area and got some appts. scheduled.  When I looked at the MRI images, it seemed quite clear (even to my untrained eyes) that I had torn the tendons (squiggly, non-connected tendons and a very large hematoma) and this was confirmed by the MRI report the next day.

I saw three OS’s in the first two days after I was back in CO and selected the one that seemed best for the surgery.  I had the surgery exactly 2 weeks after the injury.  The outpatient procedure apparently went well – horizontal cut right along the crease between the buttocks and top of leg, find the tendon stumps and the ischium, drill little holes in the ischium, place some anchors in the ischium and sutures in the tendon and hoist the tendons and muscles back into place like a sail (all in about an hour and 30 min.).  The recovery is long and starts with 6 weeks toe-touch NWB with crutches and a large brace that restricts hip motion to +- 45 deg.  Everything has gone well so far and I am hopefully past the period of highest risk for a re-tear.  I have my 6-week follow up Dr. appt. this week and will then begin PT.  I swam for the first time (with a pull buoy) at 4.5 weeks and it was fabulous!  After easing back into walking over the next couple of weeks, the rehab protocol says light jogging by 4-5 mos. and full recovery 6-8 mos.

This whole thing has made me really realize how much I value hiking and just being able to go for an outdoor walk, though I am sure if I am able I will still be trying to run next spring!  Thanks to CrankyAnky, who helped me with some good research on torn hammies and gave me some great and timely advice!  Hopefully by this time next year I‘ll be back to just reporting on my OCD ankle!

10

Ankle / Re: Getting back to basketball after biocartilage surgery

« on: January 28, 2017, 02:45:10 PM »

Hi Meem, welcome to the group and sorry to hear about your son’s injury.
I am not a basketball player and not young like your son – and have not (yet) had surgery – but I’ll take a shot at some answers to your questions.  There are a number of very knowledgeable people on this forum, so they may be able add to or correct my information.

Unfortunately, as you have probably already gathered, ankle OCDs are problematic injuries.  From what I have seen from people on the forum, recovery is a pretty slow process -- from months to well over a year for complete recovery. Your son being young should definitely help his healing, so maybe somewhat quicker for him. However, there is potential to damage the repaired cartilage if one does too much too early, especially high impact activities like running, basketball, and soccer, so he should be patient in the recovery.

Your question about just playing with the pain is an interesting one.  There is a good consensus that OCDs will not heal on their own and will get worse over time. The worsening might be gradual if you do not stress the ankle too much, but it can happen fairly quickly under repeated pressure from the high impact of running/ jumping.

From your post it was not clear how bad your son’s OCD is: how big is the lesion?, how much underlying bone edema is there? Also, how much pain is your son in?  Is pain just during/after running and playing basketball, or is there pain even in everyday walking?   Depending on the answers to these questions, it could be that surgery is absolutely needed for your son and should be done soon.  As counter example, I have a fairly minor OCD and have only occasional, minimal pain for everyday walking.  So at the cost of mostly giving up running (and other high impact sports), I have decided to not do surgery until things get significantly worse. Part of that decision is based on the bad outcomes that I have heard about, with patients no better to even worse off after surgery.  On the optimistic side, there is likely a self-selectivity on this site toward people with bad outcomes (the good outcome patients are out doing activities, not reading forums).  Again, I would think your son being young gives him a higher chance for a good outcome.  Alan, who started this forum, was a basketball player and may be able to add some more.

So in summary, not being a Dr. and not knowing your specific details, I cannot advise on whether to have the surgery, though likely suspect it gives the best chance for your son to return to playing basketball at a high level.  I think that leaving the ankle untreated and continuing high impact sports will make the condition worse and the surgery more difficult.  For your other question, I think some people do get to a pain-free state after surgery, but perhaps not for doing high impact sports over a long period of time.

A few other related pieces of advice:  1) Get multiple opinions from different Drs.  Find the top ankle specialists in your area, then consider looking nationally (see some of the other posts here for Dr. names) and seeing one or more of the top national Drs.  2) Try very hard to get the absolute best (for your situation) procedure done by the best Dr. the FIRST time.  There are stories of failed surgeries followed by more surgeries to correct the failure and the odds for a good outcome seem to go down with each surgery.  3) Research and consider carefully the surgery procedure type.  The two main types are DeNovo NT and Biocartilage / BMAC.  There are differences in the “material” used and other aspects of the approaches – see some of the other posts for more details.  Note – microfracture was the “old” standard and still first-line surgery for some Drs. (and minor cases) I think.   Also note – I think that Drs. tend to be either DeNovo or BMAC advocates (not many doing both?), so maybe good to include both a De Novo specialist and a BMAC specialist in the Drs. you get opinions from.

I hope this information is helpful.  It seems like there is a very wide variety on almost all aspects of this injury (severities, Dr. recommendations, insurance coverages, recovery lengths, outcomes, etc.), so please take this info just as general guidelines and do your own research.   Please post or PM any follow up questions that you have.

GOOD LUCK – really hope your son is able to get back to the level of basketball that he wants!!

Steve

11

Ankle / Re: Ankle OCD – new diagnosis

« on: August 01, 2016, 01:34:25 AM »

Kerri,  Thanks for your thought on the boots!  I bought some mid-height boots a while back and they help a lot, but now looking at some full height ones based on your suggestion.  I never liked hiking in big heavy boots, so slow to accept my post-injury situation.  Hope your recovery is continuing to go well! 

12

Ankle / Re: Ankle OCD – new diagnosis

« on: July 24, 2016, 02:10:24 AM »

BLT and Dave,  Thanks for the information and really glad to hear that you are both doing so well!
It is really great to hear your surgery success stories!   Please continue to keep us posted on how it goes and what activities you are doing.

The message from both of you and all the others on the conservative treatment seems pretty clear -- the ankle may feel good for while, even a long while, but with continued activity it will go downhill. 

I have been thinking about running vs. hiking lately.  Running has the certainty of thousands of small impacts (even easy uphill running), but hiking has the risk of twisting the already damaged ankle on uneven terrain (even with a brace on, it seems).  Recently though, I have gone to using two hiking poles and that seems to help reduce the re-sprain risk a lot.  I guess that is a pretty obvious answer, but it is giving me confidence for some more aggressive hiking. 

13

Ankle / Re: Ankle OCD – new diagnosis

« on: July 16, 2016, 01:25:45 AM »

Christina, thanks for the good wishes. How is your ankle doing? I hope you are getting some progress!!  Please keep us posted.

14

Ankle / Re: Ankle OCD – new diagnosis

« on: July 15, 2016, 02:03:57 AM »

Kerri -- Congratulations!!  That is great news!  Please keep us posted on your progress.  I hope you are able to get back to all your activities as soon as possible!!

jnj15 -- thanks for the info!  It is really interesting to hear your injury evolution and that you had a PT angle like Kerri.
My PT massages my ankle -- sometimes pretty hard and it is sore for a couple of days, but it has always settled back down.  Some of the PT exercises that I was doing irritated my ankle and I have stopped doing them -- standing calf raises (weighted plantarflexion) in particular can produce a sharp pain.  I guess this may be an impingement.
jnj15 -- I am really glad to hear that you are doing so well after surgery!!  That is encouragement for us all! 
I definitely agree that running uphill is better than downhill!

15

Ankle / Re: Ankle OCD – new diagnosis

« on: July 12, 2016, 02:33:51 AM »

Hi Kerri, 

Thanks for the info -- it is very helpful!  I guess this injury doesn't come with a "miles to surgery" indicator. 

I hope your recovery progresses well!!  It seems like it really is close to a 2 year deal for full recovery after surgery, which is also how long I waited after the injury before starting to push the running a bit.  I ran 5 mi. two days ago -- longest run since the injury.  My ankle is only a little tweaked and settling again, but running still seems like a dubious prospect for the long term.