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Ankle / Top doctors recommended?
« Last post by Tom on December 12, 2017, 12:40:36 PM »
Hi, all,

I am 26yrs old and recently diagnosed with a loose body and OCD in my ankle (I am an active soccer players for many years and sprained my ankle many times). The doctor suggested me to do arthroscopy to remove the loose body, and for OCD he will see during the surgery if a microfracture is needed (he said chances >50%).

So my questions are:

1. For OCD, it shows on MRI (9*7*4mm) but not on CT. MRI says there is no subchondral fracture or undercutting fluid signal, but mild cycstic changes are seen in the anterior talus. I wonder why the MRI and CT show different results? Is there OCD or not?

2. I am now almost pain-free (<1 out of 10) and able to cycle and walk as much as I want (very mild to non swelling after day). The problem is, because of the small discomfort in the ankle, I couldn't walk fully normally and in a imbalanced position (have to put 60% weights on another leg), and that makes my knee on the other leg feel discomfort and I am worried over time it will cause some problems in that knee. In this case, should I keep walking like this and avoid the surgery, cause I do hear a lot of risk with it, or I need to take it? My biggest concern is that my ankle will get worse after the surgery.

3. The doctor I met are from the top 26 foot and ankle surgeon list in US (https://ryortho.com/2013/10/the-top-26-foot-ankle-surgeons-in-north-america/), but he seems not very patient and the stuff are not very friendly. I met him twice, each time I talked to another young doc (his intern maybe?) for most of time, and talked to him less than 5 mins and he seemed not very happy answering my questions. I know he is surely very busy. But I don't know if I should do the surgery with him... Also do any of you have a list or know any good doctors on ankle OCD (particularly in CA)? I am now in mid-west but will work in Bay area after graduation next summer.

Thanks for any help! Though I am from Asia and don't have Christmas, still happy Christmas and happy new year to your all:)

Tom
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The Waiting Room / Re: A different kind of orthopedic surgery
« Last post by ColSteve 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!
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The Waiting Room / Re: A different kind of orthopedic surgery
« Last post by FrankLeb on December 07, 2017, 10:41:07 AM »
Hi Steve, do you have any fresh updates or advice?
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OCD Surgeries / Re: Lipofilling for best rehabilitation?
« Last post by John on December 01, 2017, 07:09:59 PM »
By the way, that looks useless. I didn't get any benefits from it.
You can find some researches, that fat doesn't contain any usefull cells, which bone marrow has.
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Ankle / Re: 4 years post-DeNovo
« Last post by Namelike on November 26, 2017, 10:07:48 AM »
Congrats so much on your huge success, thatís incredible that you are back to running.

I had DeNovo done with Dr Schon 3 years ago, so one year less than you. My OCD looks great on MRI but I have a bunch of other annoyances - I have had tendonitis in my peroneal and Achilles for over 2 years now and canít shake it. Have tried walking in a boot, multiple rounds of PT, everything, and I still feel it. It feels like a severe pinching/stiffness on the outside of my ankle and on the Achilles. It typically will start to feel a little better after it gets warmed up but for the most part it has been a thorn in my side.

Did you experience this at all after surgery or were you pretty much feeling great throughout the whole recovery? What/where exactly was your pain throughout recovery? How exactly did you get over the hurdles?

Congrats again.
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The Waiting Room / Happy Thanksgiving 2017
« Last post by Alan on November 23, 2017, 11:46:20 AM »
Hey all, wishing you a Happy thanksgiving 2017. I'm proud of the small community we've built here over the years. Hope you all have a healthy, safe holiday with your loved ones.
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Ankle / Best Coverage for Best OCD Treatments
« Last post by Melbusefi on November 19, 2017, 05:33:10 AM »
I have a posterolateral kissing talar dome/tibial plafond lesion which is pain free now, but who knows where we're going to be 6 months or 6 years from now, and if I had to undergo arhroscopy, I'd rather get some autologous mesenchymal cells involved which most (all?) providers now consider investigational and wouldn't cover or reimburse.

What to look for in an insurance provider/plan that would most probably reimburse for or cover the best OCD care and operation options?
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Ankle / Re: 4 years post-DeNovo
« Last post by Melbusefi on November 19, 2017, 05:22:50 AM »
Thank you for sharing.
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Ankle / Deadlifts, Squats And Calf Raises With Kissing Lesions
« Last post by Melbusefi on November 19, 2017, 05:11:07 AM »
Low volume, very few heavy reps just to maintain strength. What do you reckon? I work on my feet anyway and do a lot of walking. And I don't want to pamper culprit leg or let it get weak or more imbalanced.

Kissing lesion is posterolateral and pain free even in extreme end-of-range positions (#grateful). I deduced that, due to its location, it's probably non-weight bearing, and most dorsiflexion- and inversion-oriented movements aren't putting much stress on it.   

Resulted from 25month old vertical trauma, and went undiagnosed until recently. Tibial OCD is cystic. Soft tissue inflammation (and pain) is due to excessive stretching and self-administered IASTM trying to recover 8 degrees of dorsiflexion that went missing after 3 months of immobilization due to small talus fracture.

Also, how tricky is arhroscopy to get to posterolateral talus dome and tibial plafond? Found some description of operating techniques that didn't sound too nice, involving osteotomy, resection, and release of ligaments* just to access the site?





*Kennedy JG, Murawski CD. The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical Technique. 2011.



 
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Ankle / 4 years post-DeNovo
« Last post by mhop on November 18, 2017, 06:14:44 PM »
Hey, all.  I haven't been on this board in years, but I just got back from a run and thought I would post a little encouragement.

I had a pretty substantial talar OCD and multiple torn ligaments (from repeated strains).  I did surgery with Dr. Lew Schon 4 years and 1 week ago.  It has not been a linear journey to healing by any means, but I definitely don't regret the surgery.

I was running some pretty quick half-marathons before the surgery and was pretty much a life-long runner.  So, I can empathize with those of you feeling devastated about having to give up your sport. There can even be a depression that comes with the loss of endorphins if you've been an endurance athlete for most of your life.

The last 4 years have been interesting but mostly good.  I found a lot of activities I never thought I would like outside of running, and I now love these activities.  I prefer climbing to just about anything these days. 

I took a few years off from running.  However, I picked up running a few months back when I had a minor overuse injury to my shoulder and had to take a break from climbing.  I now run 1-2 days a week and do occasional sprints.  (The funny thing is that after years of being ADDICTED to running I no longer like the sport all that much.  I mean, it SUCKS if you don't do it regularly.)  I run very short distances now at a very slow pace.  The cardiovascular research would show that that is physiologically better as we age.  (I'm 35 now.)  But, for what it's worth, I CAN RUN AGAIN.  And I have set a small goal to race a 5k in a few months.

So, I just wanted to pass on encouragement to others that 1) you very much can find other passions while your joint can't take the pounding of your sport.  For me, it was a grieving process of sorts, but over time, I got to where I was no longer sad about being unable to run.   2) The healing process after surgery can be slow but very worthwhile.   3) I think Dr. Schon is an awesome surgeon.  I remember my OCD being large and complex with other joint issues, but it seems now that the problem is at least 90% repaired.
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