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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!

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The Waiting Room / An Emotional Test

« on: August 04, 2014, 02:21:53 AM »

Alan and others on this forum have written some great words about the emotional aspects of the ankle OCD injury that have helped me deal with this.

As someone who absolutely loves running and triathlons, my ankle OCD (Aug. 2013, still holding on with conservative treatment, but not running), has had a significant emotional toll on me.  I have stayed pretty upbeat, but it still hurts to see people go jogging by.

I had a good emotional test today as there was a full Ironman Triathlon nearby in Boulder.  I did a half Ironman a few years ago and doing a full Ironman was one of my lifelong dreams.  After waking up saying I didn’t want to be anywhere near the Boulder Ironman, I knew I wanted to go down and see it.  I went down in the evening to the finish line to watch the athletes roll in.  It was really emotional, listening to the announcer call out each athlete by name as they crossed the line, and tell them, “You’re an Ironman.”

I so badly wanted to be one of them, and knew that without this ankle OCD, I probably could do it (albeit with a pretty slow time).  Then my ankle felt a little better and I was scheming again, how can I beat this, maybe as the last thing I did before surgery (nah, seems like a dumb idea), maybe I could walk the marathon. I think I could avg. 4 mph = 6.5 hrs for the ‘thon.  That could work.   

Then as I headed to the car, my ankle started hurting more and I sank back into reality.  There isn’t going to be an Ironman for me and in 12 hours I was going to be walking, with a slight gimp, back into another work week.    But, I told myself,  there isn’t going to be an Ironman for most people and they find a way to survive, so get over it. 

I am still really glad I went to see the triathlon, to get a glimpse of the exhilaration. And my Ironman dream lives on as a tiny flicker of light, however unlikely it may be to ever come true.  But hey, who knows, maybe in 15 years, the docs will conquer the demon of regrowing cartilage and it will be good times for us all!!   Steve

3

Ankle / Ankle OCD – new diagnosis

« on: January 05, 2014, 11:45:32 AM »

Hi Everyone,

First, a big thanks to everyone for their posts and to Alan for organizing this forum!!

Three days ago I got results from an ankle MRI and found out that I have a 3 x 8 mm lesion on lateral talar dome and an adjacent subcortical cyst in lateral malleous (5.5 mm) + an old partial tear in AITFL (no diastasis).  Before that I had no idea what a talar OCD was, so I have been on a steep learning curve since then -- including finding this great forum.

History:
Male, 51, CO Front Range area, active (hike, ski, triathlons), love running.
Aug 2013 -- bad ankle sprain while running, came down half on curb, outside of foot went down hard and unsupported.
Oct 2013 -- Rest ~ 2 months, then worked back to running, mostly painless, thought I was healed.
Nov 2013 -- Seemed to re-sprain ankle on hard downhill run
Dec 2013 -- Ankle X-Ray, no fracture, slightly wide medial space, DPM suspected possible syndesmosis injury, ordered MRI
Jan 2, 2013 -- Got MRI results -- my OCD journey begins.

DPM Plan: 
Ankle arthroscopy , Talus -- OCD debridement / Microfracture,  Malleous -- excise cyst, pack bone graft / cartlilage graft. 
Little explanation / time for questions from DPM, surgery not presented as being a big deal. 
Asst. said surgery could be done as soon as following Mon. morning (tomorrow) and to plan on 4 weeks NWB.   

I started web research as soon as I left Dr. office.  Quickly learned how problematic this injury is and that I needed to do some careful research before any surgery. 

A couple of key themes for me so far (among the many):
1. Many stories of limited success from MFrx surgery
2. Some glowing reports for DeNovo NT 

Based on this, I found a Denver DPM with paper on DeNovo and excellent credentials / reviews and scheduled an appt. for a 2nd  opinion. (this Fri. 10 Jan).  I am working on a list of Denver area potential docs (DPM and OS) for additional opinions.

My current condition:
Slight pain on weight bearing / walking -- bit of a dull ache in ankle/heal that gets better after being NWB.  Occasional sharper twinge of pain near outside ankle knob.  Wearing a lace-up ankle brace.  Pain seems to gradually be getting worse – I am sometimes avoiding putting weight on that leg.

Some (of the many) things I am wondering about (understanding no docs here):

1.  Timing of surgery – how fast can the condition get worse.  Are subchondral cysts the biggest risk and how fast can they grow?  I am thinking I should totally curtail exercise (already down to swimming, bike trainer) until surgery (DPM was vague on this question).

2.  DPM vs. OS?   Will I get a narrower assessment of treatment options by DPM?
-- someone told me to be careful with DPMs, as they are not MDs (cannot do OATS or need assist on harvest).
In contrast, it seems like DPMs are more focused on this condition, much of the research on it is from them.

3.  Strategies for finding best surgeon?  Is there a list of top surgeons nationally, their specialty / treatment preference and location?

4.  Contraindications for DeNovo?  I apparently have a small “dent” in corner of Talus, wondering if DeNovo not appropriate for that, because bone “fill-in” needed.

5.  Arthroscopic vs. osteotomy  -- How big a priority to avoid osteotomy – it seems so invasive?  Is it correct that osteotomy is less likely for lateral OCD compared to medial?   Osteotomy more likely for any bone graft technique?

6.  Greater than 50 year old patient --  Reduced success chances? Bad candidate for any autograph techniques?

7.  Anyone have experience with sub-cortical cysts in lateral malleous?  -- This is more prominent on my MRI than the talar OCD.  Interesting that the DPM verbally mentioned “juvenile cartilage cells” for the malleous, but not the talus (this was before I had read about DeNovo).

8. Co-occurring syndesmosis injuries?  I have hardly seen this mentioned in OCD forums – is it not common, even for severe ankle inversion OCDs?   

Sorry so many questions -- I will hopefully learn a lot more after my 2nd opinion this Fri. (maybe Mfrx is the obvious first treatment).
I look forward to sharing my story as I go forward and hope for the best outcomes for everyone dealing with this condition!!

Steve