My new injury - what is ostechondritis dissecans?
So, I am now waiting for the final date of my new surgery. Hopefully before Easter. But what is ostechondritis dissecans, and what are the prospects?
The latter first: Not good, actually. While there are a wide range of available treatment options, none of them has delivered consistently good results over time in adults. From the few forums on this injury I have found, it seems like some 50% suffer life-long disability in the affected joint. About 0% has taken up running after surgery. The scientific litterature on the subject isn’t large, and it is generally optimistic. However also written by those who tries to specialize in treatment delivery, hence they have a strong incentive to be optimistic. Hence, I will not be subject to any of those fancy techniques, rather, the fragment, which is bout 17×7 mm in size, will simply be removed from the joint.
With two toddlers at home, I am not ready to get a new ankle joint at the age of 33. Now, my ortho doesn’t think I need that, he is quite convinced that I will be pain free for the rest of my life, just not being able to do any running or jumping based activity. Like playing football or basketball with my kids. Unless, he said, my articular cartilage proves to be intact, sound, and healthy. Something my MRI claim it is, but also something he has never seen under such circumstances. He has done something like 50 or 60 arthroscopic fragment removals, so I bet he knows what he is talking about.
Now, here is what the injury looks like (I am not managing to upload the picture… Help?):
And here is what Action Sports Physio (the best internet source I found) writes about it:
Evaluation and Treatment
Proper diagnosis will minimize the risk of long-term disability and provide the patient with more treatment options. Diagnosis begins with a proper physical examination followed by X-Rays. Your doctor may also request a bone scan or MRI to aid in the diagnosis and to pinpoint the extent of damage of the area affected.
If the patient is young and the bone is still growing a conservative treatment approach of complete rest will be suggested. All activities will have to be stopped and may require a period of non-weight bearing of several weeks. The treatment period could be as long as 12 – 18 months and will require follow-up X-Rays, bone scan or MRI to evaluate the progress and healing process.
If no progress is made or the healing is slow, surgery may eventually be required. In cases where fragments of cartilage are loose in the joint, surgery is necessary to either reattach the fragments or remove them to limit the irritation they can cause. The extent of the damage will decide the type of surgery, arthroscopic or open.
Rehabilitation and Recovery
Post-surgery rehabilitation will involve a period of non-weight bearing and require an extensive period of physical therapy to regain range of motion, strength, flexibility and coordination. The goal of rehabilitation will ensure proper and progressive weight bearing and to control pain. Ideally the goal is for patients to resume their previous lifestyle. Continued supervision and check ups with your doctor and therapist will be required to evaluate the effectiveness of the treatment an the evolution of the cartilage for degenerative arthritis.
Osteochondritis Dissecans is an uncommon but potentially a significant debilitating injury to young athletes caused by direct trauma or repetitive stress. Early diagnosis is imperative for proper healing and recovery. Surgery may be required with an extensive rehabilitation program to aid in the recovery and eventual return to physical activity.
Underlinings are my own.
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Good luck! Ever encountered “The Median Isn’t the Message” by Stephen J Gould?
Thanks Norm, that gives some kind of hope! And no, I hadn’t heard about it before.
As I have made a full recovery of my ATR in 10 months, why not also from OCD?
Today I tried to do the one-legged full heel raise. Without support - even for balance. Well, I can’t do a full heel raise because this fragment in my ankle blocks my ROM when I put weight on it. But I can do them almost two inches high. I did 25. Hands in pockets.
I’ll call that a full ATR recovery in 10 months. So let’s see what the OS says about my cartilage when he opens me up a week form now. If I’m anywhere far away from arthritis, I’ll run the Comrades next year.
Top end of the upper statistical range
If I could recover from the OTHER kind of OCD, maybe I wouldn’t spend QUITE so much time on this wonderful site!
Hi Tord, by my calculations and the calendar seems like you would have already had the procedure to treat the Osteochondritis dissecans? Hope all went well and you are back on the road to recovery for that
It still amazes me a bit that such a fragment — I mean 17×7mm is only about 0.6×0.3 in inches — can wreak such havoc. Though after typing that last sentence and using my fingers to “measure” the size, I guess maybe it’s not soo small when compared to the overall size of a foot/ankle.
Good luck and hope you feel better!
Jon
p.s. a couple weeks ago you posted Re: Scott Jurek on my blog. I looked him up — had never heard of him before, nor ultramarathon as a sport. It’s cool stuff! I have done some running, mostly jogging in my younger years, but never had the patience nor stamina to be able to run anything close to those levels. But the high end, the ultra athlete fascinates me. I mean the concept of running 50, or a 100 miles, or for 24 hours blows me away.
Jon,
Yes, it’s been almost a week already. I was thinking to write a new post about it, but I haven’t really had the motivation for anything the past couple of days… So thanks a lot for the reminder!
Now, the surgery actually went much better than expected, so I was off painkillers after 12 hours, PWB after 18. That is pretty much better than after ATR surgery, to say the least. I’m currently around on crutches, but already getting lazy to use them properly, so I take a few steps FWB every now and then, which I think is a good thing as long as it is controlled and pain-free.
And sure, I agree that you may ponder a bit how such a small fragment can really wreak havoc, but then again, if it’s inside the joint, stuck between two bones that are supposed to move against each other, it is perhaps not so strange after all. Imagine having a rock that size stuck between the piston and the cylinder wall in your car engine…
Regarding Scott Jurek, I think he’s areally inspiring figure. Both in terms of ultrarunning and in terms of nutritional philosophy. Even for meat-eaters, Jurek has lots to offer. Iam cleared to run again, by the way, as my joint appears to actually be a positive statistical outlier, however, so far, it will be limited to some 5k per week. Not exactly ultra, but certainly much better than nothing!