Osteochondral Lesions Of The Talus - Everything You Need To Know - Dr. Nabil Ebraheim
ฝัง
- เผยแพร่เมื่อ 13 ก.ย. 2024
- Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus.
The cartilage thickness of the talus is 1-2 mm, it receives at least 5 times the body weight during normal ambulation, and about 60% of the surface of the talus is covered by cartilage.
It’s not unusual for OCD lesions to occur in the talus.
More than 10% occur bilateral and OCD lesions occur more in males.
About 6
6% of the patients with ankle sprain will have this lesion, and a lot more patients will have the lesion if they have an ankle fracture,
The lesion also occur in patients that are having lateral ligamentous reconstruction.
The lesion may be a contributing cause of the ankle instability.
Most of the patients with symptoms usually play sports and are very active.
Some believe that the primary cause of the OCD lesion is trauma, however this is controversial.
The patient may have an acute fracture, repeated micro trauma, or the patient may not have a history of trauma at all.
The patient present with either acute inversion injury or chronic ankle pain with swelling, catching, locking and possible ankle instability.
When the patient complains of frequent instability of the ankle, the evidence of ligament laxity on stress view x0ray are usually absent.
Most of the patient who have symptoms are usually active individuals in their 20’s or 30’s.
Get x-ray
Beside x-rays, there are other studies that should be taken.
You can get an MRI which is the study of choice if you suspect the lesion.
When you treat the ankle sprain and it does not get better, you want to rule out an occult lesion of the talus.
A fluid signal behind the lesion on MRI indicates that there is a continuation between the joint and the lesion; the lesion could be unstable and less likely to heal by itself.
You can get a CT scan which is the study of choice if you know there is a lesion and you want to follow that lesion.
It is interesting how the x-ray staging and the MRI staging are almost close in comparison.
x-ray staging:
1- Subchondral compression fracture.
2- Partial detachment of the fracture.
3- Complete detachment of the fracture with no displacement.
4- Complete detachment of the fracture with complete displacement (free fragment).
MRI staging:
1- Articular cartilage edema.
2- Fracture similar to the x-ray.
3- Fracture that is detached but not displaced.
4- Completely displaced fracture fragment. (Stage III and stage IV appear the same as in x-ray stage).
5- Subchondral cyst formation.
It should be noted that the radiographic and the arthroscopic findings do not always correlate.
What are the lesions that you will usually see?
Two types of lesions:
• Posteromedial
• Anterolateral
I find that these lesions are actually opposite to common sense understanding.
The medial lesions:
• Common
• Usually non traumatic
• Larger /deeper
• Posterior
The medial lesions are less symptomatic.
The lateral lesions:
• Less common
• Traumatic
• Smaller/ shallow
• Anterior or slightly central
The lateral lesion is usually symptomatic and difficult to treat without surgery, it has a lower incidence of spontaneous healing and becomes displaced I the joint and symptomatic.
Displaces means that the lesion is a stage IV I either the x-ray or MRI classification.
Usually this lateral lesion occurs due to an inversion or inversion dorsiflexion trauma.
Treatment:
You treat this lesion conservative first by non- weight bearing, short leg cast, or a boot for 4-6 weeks especially if the lesion is acute and nondisplaced.
In general, if the lesion is a lower grade lesion such as stage I or stage II, you will treat the session conservatively.
Surgery is done if the conservative treatment fails.
Surgery is also done if the lesion is a high grade lesion such as stage III or stage IV by MRI.
Surgery is usually done arthroscopic.
In general, if the lesion is a lower grade lesion such as stage I or stage II, you will treat the lesion conservatively.
Treatment of lesions stage III and stage IV is surgical.
Non displaced lesions are treated with immobilization and they may heal.
Regardless how the lesion appears on x-rays, if the patient is asymptomatic after conservative treatment then observe the patient even if there is no evidence of healing of the lesion on x-ray or MRI.
Loose fragments on x-rays are indication for surgery.
If it is an acute fracture, especially the anterolateral fragment, consider reduction and fixation with bioabsorbable.
If the OCD lesion is less than 1 cm, then you will do excision, curettage, or drilling of the lesion.
If it was greater than 1 cm with cartilage intact or the cap intact, you will do retrograde drilling or bone graft.
If the lesion is greater than 1 cm and displaced, then you will do open reduction and internal fixation or you will do osteochondral grafting.
![Why is My Sprained Ankle Still Painful & Swollen? [Causes & Treatment]](/img/n.gif)
I had this pretty bad and was told it was just a sprain, I played an entire season of high school football in pain until I finally got surgery from a local surgeon and it failed (the doctor sucked) I went to NYC and had the OATS procedure done at the hospital for special surgery and a little over a year later I can honestly say my ankle is pain free and feels stronger than my other ankle that I have never had an issue with 😁
DracoWittaDick awesome, who was the surgeon you used? I need the same procedure
joepanic66 did you use dr kennedy?
Your comment gave me hope.
How much it was?
I had two surgeries before having OATS at HSS - 2006. I had Dr Kennedy. However, I was Never able to return to running.
Extraordinary video!
I learnt a lot.
Thx for sharing.
Brilliant explanation, very helpful!
Glad it was helpful!
I'm an ortho-trauma trained scrub nurse, it would be an honor to scrub for you Mr. Ebraheim. I always find myself watching your vids whenever I'm free.
Thank you nabil from the great explanation , we hope see more vides like that .
Thank you very much for this video. I will understand what the specialist is saying when I see him about my "1.4 x 1.0 cm osteochondral defect in the posteromedial aspect of the talar dome with findings of instability/loose fragments." I look forward to the day when I no longer have to walk up a hill or a step sideways. :)
thank you sir Dr. nabil
great efforts
Thankyou so much and greetings from Sweden. My cat tried to kill me on the stairs. You provided more info than I would EVER get here. The docs here expect us be able to read their minds or something.
this video is very helpful
Thank you! Do you know how long after the arthroscopic surgery you can start running again?
Do you have an answer so far :) ?
@@c.g.jonesze9089 no. Do you?
@@RemoPeter no but I heard like 2 week crutches
+ week crutches and Moon boot
+ 4 week moon boot
Something like this
Until someone could run again it's a few month but I'm sure it diverts from case to case.
You are always helpful, thank you ❤️
thank you for this useful information
Advice needed: I am a young and active female with an anterolateral talar bone edema of 9mm plus some light cartilage damage (shown in two MRIs) due to an inversion sprain more than 1 year ago. This situation seems like a Stage 1 OLT in your classification.
My doctor says my edema should “heal itself” with use (as long as I avoid high impact), or we should do surgery. I have followed my doctor’s advice in using my foot, but it’s been more than a year and I’m limping everywhere with pain and am exhausted and sad that I can’t do sports or even move around my house without pain. My doctor is adamantly against immobilization and non-weightbearing you mention in your video, saying I’ve been looking at bad sources online. This is very confusing as many sources say that you should try immobilization first. I understand that immobilization is bad for ligaments and muscles, but I also read that talar bone edemas need some rest to heal.
I don’t have the option of changing doctors due to my medical system, until 2 months from now when I move from the public UK system to the US system. Would you walk and use this foot during these two months?
I had one but mine was stage IV so surgery was done to remove the displaced fragment and place external fixation for two months. It was never the same after and now I have another lesion on the tibia, it is type V with a 1.3 cm x 1cm cyst. I had surgery on it in June (it was smaller then and has expanded since surgery) and it still has not healed. I feel your pain and it is all very confusing! Especially when you want to be active and can’t due to the limitations that come with the injury. I think some doctors have the same idea though, mine also feels that immobilization does more damage in many cases. But when you have the opportunity definitely get a second opinion if your still having issues! Have you asked your doctor about immobilization? Maybe they would take into consideration your research or explain why they feel otherwise? Best of luck with your recovery!
I've had a lateral lesion in stage 3 and around 1 cm from 2 years ,and I'm afraid of doing surgery and I'm trying to cope with it ' 'I live on painkillers and anti-edema 😭
Two weeks come normal, then a tiring week
And during my experience after immobilization , it turned for the worse because there was weakness in the muscles 👎🏻
@@brianagambucci-heater6058 hola como sigues
Great video and explanation. However, I wish you would have discussed Stage IV of the mid medial lesion. My child has stage IV large mid medial lesion after a severe avulsive-type ankle sprain and having issues resuming normal sports activity. There has been arthroscopy with MRI before and after because of continued issues. Fragment still noted on last MRI. Thank you!
Thank you so much for this video.
thanks for this medical information ...
To any fellow sufferers of this-did you find it painful-not during, but after a long walk? And when it stiff-ens and is painful, can you "walk it off" after walking 100 yds or so? I am 54, dont recall any traumatic injury, but MRI confirms that this is what I have. It also would catch or buckle with certain random movements, and is almost unbearable on that ankle, thus I lead with the other ankle going down stairs. He gave me a steroid shot in it, which hurt like the dickens, then caused a massive depression 3 days later, but the ankle itself feels like I am 15 again. He said it would only last 2 months or so. I wont have another one.
Thanks.
Yes i had this exact thing. Exactly what you're describing plus when i took off my shoes from the walk my ankle was literally black and blue like someone had stomped on it. But i had surgery for mine cause my bone was about to dissolve away. I'm 22 and i had it when i was 17.
I'm 35 and I'm a security guard. one day I was just on patrol going up a hill and a sharp pain hit my right ankle. It was so bad I had to go back inside and lay on the couch for the rest of my shift. As a security guard I have to walk a lot. I usually average around 12k - 20k steps in a shift. I find that the more I walk the worst it gets which makes sense as it stresses my ankles out so I've found myself not walking as much. It's not bad when I'm on a flat surface but when I go up hills is when it really starts to hurt. My cunt of a boss doesn't allow foot stools for our posts when we sit in high chairs at work so I'm pretty sure I sprained my ankle trying to use the electric box under the computer as a foot stool (it made for an awkward foot stool where I had to twist my ankle to have it rest on the electric box. The x-ray I got said the size was 4mm. The doctor said it was too small to have surgery done so all he recommended was some voltaren cream and a cheap ankle brace on amazon. I still have yet to use them to see if will make any difference and heal on its own (I have low hopes of this happening but fingers crossed it works). This happened over the summer so it's been about 8 months and it still hurts especially if I walk long distances uphill.
hola como sigues
@@AshleyBenics y como estas ahora q operación bte hicieron
Thank you......sir plz upload some videos of plates and screw biomechamics .
very helpful
thanks dr. nabil.
Had denovo done in 2016 for lesion on taler dome. I can be active and play basketball without much limitation. Currently following a low inflammation diet and get plenty of sunlight.
Thank you for this video! I understand to limit mobilization. I have a legion in the 1st stage on the posterior side of my ankle, and I was wondering if I could do strength exercises that do not impart heavy loading on my joints, such as calf-raises or circulations? Thank you!
how are you feeling now?
I got 2 bone cysts from septic arthritis. Id like to get them removed or treated, because the spot they are in sucks.
Can a torn meniscus cause foot and ankle issues? Ever since I tore my meniscus I been having ankle pain recently had an mri and have this problem now mri report says tibiotalar joint space with osteochandral lesion
Ankle talus bone fracture after one month plaster, & xray doctor told me osteochontral injury my cartilage is damaged. please tell me anybody without surgery Treatment this injury ? Ankle strengthening good or bad ?
Sir you are too good
What is the effectiveness of shock wave treatment for stage 1/2?
Hola
very nice.
Thank you very much Doctor , I have bilateral OCD , the right foot hurts more and it's medial , I tried to reach you in Facebook , who knows anything about it , please contact me.... it's annoying pain and makes me so depressed.
How is it now :)?
@@c.g.jonesze9089 it’s the same , the doctor told me he’s afraid if he touch it , it may go worse
@@Hurtadodejalo I purchased a mri therapy instead of retrograde drilling, it costed me 800 Euros and helped 0 % 😄 stay happy and hopefull in 10 years we may laugh about it.
@ similar to my case after 3 years same and doctors tell me same 🤔
Thanks Dr i had this OCD in my ankle and my lesion was 1.4cm and i had the surgery done where they broke my ankle to fix it. Then they put it back together with 2 screws. It all good now.
Ashley Benic s2974281 how long was the recovery? Are you in physical therapy? I'm scared of ankle surgery
Hey Joey Peterson recovery was a while for it i was 2 weeks in half a cast the 4 weeks in a moon boot with still no putting pressure on on then 4 weeks walking with a moon boot then another four just walking with out and then really slowly learn run. so it took a while but my surgeon sent to to a great physio for recovery and it helped a lot with the healing process. However,my ankle feels completely fine like nothing happened. And believe me i was petrified to get it done as well even cried on the day but to be honest was that bad they put you to sleep and then you wake up it honestly feels like you have closed yours eyes for a seconds and then open and they give you morphine. But honestly its not that bad you will be ok:)
Sorry it WASN'T bad and i can do everything again like running and swimming (which is the sport i competed) in so it will be all be good
Thank you so much for the quick response. Hard question but when along the process might it be able to work again? (I'm a waiter)
I believe around the more like around the 9-10 week mark when you start walking with the moon boot. But its all on how your ankle feel and how everything is going. But just take it easy cause your only going to be able moving slowly (slower than a usually walk, well that was me anyway). If its still a little sore take a break cause i went to work as well and told them what had happened and they let me take a couple of 5min break here and there. And it also depends on how thing are healing. Cause even though i was walking my bone still hadn't completely fused together properly so take it slow and give it time. But my ankle if completely fine know. Best of luck with you surgery and don't stress :)
thank u very much....
Thanks !!!!!!!!
Thank you!
I'm in the last stage ,I have been in this situation for 2 years now , I can walk thu but can't run, it hurts like always can't push myself or do hard activities, anyway s I'm planning to do a surgery inshallah.
How are you now?
THX MUCH
how bad is a 50mm Lesion on ankle?
Pretty sure I have this right now. Sprained my ankle pretty bad about 3 years ago, took 2 1/2 months to feel better. Now, this last year I have a very sharp pain if I step in such a manner that it feels like my top ankle is folding over the top of my foot. Not sure how else to explain it, looking at the figures, it is exactly where the lesion is of the talus under the tibia. Although it is the front right side.
How are you now?
Help me! I had a stage 3 medial lesion on my right ankle and all they did was debridement and nothing else, how long is the recovery and when will I be back to football!? Please help!
Hola cómo sigues
How are you now?
Chronically injured. I wish I would have just used crutches for a few months and let the cartilage heal itself rather than have it removed (I had a piece of cartilage partly disconnected, like a trap door, on my talus).
@@baseballxlove y como sigues?
Bien!
They told me there’s going to do micro fracturing on my OCD. I am hesitant about this because of fear the fibro cartilage might break down soon or later. Doctor, what do I do?
Dr how can I find you I have this case and Doctors haven't treat me well
Sir I have done this (OLT) surgery sir would you tell me after how many days i will do weight bearing on ankle and how long I will get back to sports please reply sir
And after surgery how many days should i do physiotherapy sir please reply
My sincere advice to you is that don't go back to sport again if you love yourself. Dear I m suffering.
Thanku sir
great summary...except, the rehab portion. The peroneal muscles are a relatively small contributor to ankle stability, EVEN in the case of a lateral ankle lesion. Reserach shows more lateral instability with a weak calf for example, which makes sense as the powerhouse of human locomotion as it pertains to the ankle. There are also proximal factors like hip function, knee function, footwear, training errors, taping/bracing, and sports specific and unique personal recommendations etc. that all become the backbone of rehab. Again, I appreciate the summary, but I wish the rehab was not reduced down to "peroneal strengthening" for ankle stability.
Hello Kris, you seem like you know what you're talking about. What do you think about the non-weightbearing part? I told my doctor about it, and he's adamantly against it. But the explanation on this video is in line with several others I saw online.
I have on the middle ! On talus
Oxigenhiperbar
this is what I currently have. I’ve torn 2 ligaments completely, fractured my talus, sprained my ankle, damaged my cartilage, and torn another ligament in half. Getting surgery on the 24th, and looking how shitty these doctors can be, I’m praying to the lord everything goes according to plan.
I have a stage 2 osteochondrial lesion of the Talar dome, first I tried non surgical method such as casting which didn’t work, then I had a micro fracture surgery and am 6 months in and it still hurts in that general area, any suggestions, I’m 16 btw.
Don't wait 20 years to get it treated like i did
@@pigup2 Same here. Waiting decades hoping it can heal itself. Just got worse.
I need some guidance. I have a medial osteochondral lesion that measures 1cm in width at a depth of 3mm. I have been in intermittent pain and loss of function for at least 2 months. I also have a single deep fissure in my patella which my doctors opted to follow a conservative treatment plan ( ha, prp, physio, shockwave, laser.). I understand the philosophy of leaving alone injuries which don’t involve large areas of cartilage or bone but, I am wondering if conservative management of a lesion on the talus with those dimensions is the right course of action? Is surgery Inevitable when the lesion involves bone, and will the longer my doctors wait possibly increase the likelihood of progression to Arthritis?
Its a huge lesion. You need open surgery of ankle and take cartilage from knee.
How are you now?
I'm 35 and I'm a security guard. one day I was just on patrol going up a hill and a sharp pain hit my right ankle. It was so bad I had to go back inside and lay on the couch for the rest of my shift. As a security guard I have to walk a lot. I usually average around 12k - 20k steps in a shift. I find that the more I walk the worst it gets which makes sense as it stresses my ankles out so I've found myself not walking as much. It's not bad when I'm on a flat surface but when I go up hills is when it really starts to hurt. My cunt of a boss doesn't allow foot stools for our posts when we sit in high chairs at work so I'm pretty sure I sprained my ankle trying to use the electric box under the computer as a foot stool (it made for an awkward foot stool where I had to twist my ankle to have it rest on the electric box. The x-ray I got said the size was 4mm. The doctor said it was too small to have surgery done so all he recommended was some voltaren cream and a cheap ankle brace on amazon. I still have yet to use them to see if will make any difference and heal on its own (I have low hopes of this happening but fingers crossed it works). This happened over the summer so it's been about 8 months and it still hurts especially if I walk long distances uphill.
como sigues
How are you now?
I have a stage ll lesion and the doctor told me That they need to do a surgery, should i go for another doctor. Since the treatment should be non surgical for a stage ll or l ?
Mine is stage 2 too and i immobolize it and it didnt work so i have to go for surgical
@@alirezayousefi3687 same here
How are you now?
I had talus necrosis in the middle of the talus
How did it work out so far?
Awesome
❤❤
Can you find speak another person english?