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Old 02-08-2010, 11:54 AM   #1
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Ankle OCD in my 13 year old daughter

Hi All,

Just discovered this forum as I was searching for info on microfracture surgery for talus OCD. Interested to find others with this problem, and looking for some thoughts on a situation I'm debating.

First, my history. In 1989 at age 23, I was diagnosed with OCD (at the time I think they called in avascular necrosis (sp?)) in both my left and right ankles, on the dome of the talus. I was very active, ran 10 miles a week, played basketball in a mens league, was a newly hired professional firefighter, etc. The lesion on my R talus was more significant than the L, and was the predominate pain source. Several OS told me my career as a firefighter was done, while others felt it possible to continue given successful surgery. You can guess who I listened to. Well, I had drilling done on my R ankle in 1990. All the OS I had seen, including the one who did the procedure here in Seattle, stated I'd be non-weight bearing for 4-6 weeks. Imagine my surprise when during my first post op visit 1 week after surgery, the OS said I could get rid of the crutches and bear weight. When I asked why, he said because the lesion looked better during surgery than he'd thought, which was BS because after surgery I asked how it had gone, and he stated "about like I thought". That was the last time I saw the guy, as I reverted to another clinic who I had almost gone with for surgery. I did bear weight for a few days until I could get in to see that group, whereupon they immediately put me back on crutches for 4-6 weeks.

Trying to make this part of the story short, in the end it took me three years of popping anti-inflams before I got back to even with where I had been pre-op. I was barely able to make it career wise through this period, but after that could manage if I treated my ankle right. What this means for me is no impact sports, no vigorous cycling, etc. If I abide by this, I am relatively pain free, I can walk vigorously pretty much unlimited, I can swim, do eliptical, etc. In short, I adjusted my lifestyle, and kept my career. The point to this whole story is that I'm personally familiar with ankle OCD. My left ankle has always trailed my right as a source of pain/problem, and thus I've never had a procedure performed on it. I did have some MRIs done a year or so ago, just sort of as an update of my status. The lesion looked about the same, however the doc did note some OCD at the end of my right leg bone - can't recall if it is the tib or fib.

Anyway, my 13 year old daughter recently came up with the same problem. The MRI is an uncanny copy of my own. The docs we've seen say they've never heard of a genetic connection, but I can't help but think there is. My daughter has been a very active kid, did ballet until two years ago, and loves volleyball and soccer. After some on/off again complaints of ankle pain over the summer of '09, we took her to the dr. when the pain after a soccer tournament became significant. The diagnosis came 8/09, and prescribed treatment was to stop all impact sports/activities and see what happens. A followup MRI came 4 months later at the end of '09, indicating no change. The sports medicine doc we're seeing advised us to continue the course through this spring, and do another MRI 6/10 to give the body every chance to heal itself considering the young age. He did encourage us to see a surgeon in the meantime to see what they thought. We went to see a surgeon in Seattle who had treated an early 20s woman pro soccer player for the same, and successfully performed microfracture surgery on her. She is now playing competitively again. This surgeon feels my daughter is a candidate for drilling, stating 4-6 wks NWB and a gradual resumption of activity after 3 months. He is on the fence as to whether to wait for possible healing, saying it's possible, but perhaps unlikely based on the lack of progress over 4 months. He thinks opting for the surgery at this point is a reasonable approach, though offered that my daughter would be the youngest pt. he has performed the procedurre on.

Obviously I'm distressed over the age that this is happening to my daughter. Beyond being totally dejected by the lack of ability to participate in sports, she is simply bummed to not be able to do normal kid activity. At this point I'm leaning towards surgery, as am rather peissimistic that natural healing is likely. Of course I'm petrified that her response will be the same as mine was 20 years ago (3 yr. recovery, and never any better than pre-op). On the other hand she is very young (5'2", 100 lbs, growth plates still open), and will benefit from better post op advice about weight bearing.

In the end, I'm interested in the groups thoughts. I've read some threads that seem to be posted by other folks with less than successful drilling procedures, who have opted for OATS. Are there folks out there who have had good results from drilling? By the way, while I can't recall the measurement of my daughter's lesion, it was spoken of as relatively small, and I'm thinking maybe 5mm?

Thanks in advance to anyone with pearls of wisdom!

ee

 
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Old 02-12-2010, 06:42 PM   #2
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Re: Ankle OCD in my 13 year old daughter

Hello EE,
I have had two debridements, one of which was coupled with drilling. The first debridement I had done I was 21 years old. The doctor that did the clean out left the hole there and did not do any drilling or take any measures to get the bone to grow back. I had the other debridement/drilling in 2008 at 29yrs old. It worked partially and I truly believe that if my first surgery was done by the doctor I have now it would have been a success. I had an OATS done this past november and I feel great! My surgeon told me that I was one of 3 failed drillings he has had, due to the first surgeon that horribly messed up my ankle. The drilling is a good option for your daughter due to her age and activity level. Find an OS that specializes in the ankle joint! (very important, I cannot stress this enough) Also ask your OS about a bone stimulator, an ultra sound machine that goes on your ankle to assist the bone to grow. The talus bone is a small bone but a big pain! The size of the lesion will grow larger without being taken care of, I had my oats at 10mm. This is just one opinion from someone who has been plagued with an OCD. Good luck to you and your daughter! -Lauren

 
Old 02-13-2010, 04:41 PM   #3
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Re: Ankle OCD in my 13 year old daughter

Thanks for your response and thoughts. Unfortunately I haven't heard from a single person who found drilling successful. Hope this indicates that those who've succeeded with drilling don't linger on message boards re. foot problems.

 
Old 02-14-2010, 07:29 AM   #4
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Re: Ankle OCD in my 13 year old daughter

5mm is a good size for drilling. They won't do OATs on an oCD that size and usually they have to do drilling or microfracture first. I've also read that young kids heal from the OCD's much better than those of us that are older. She may have great success. I'd opt for drilling and see how it goes.

Probably there won't be many people posting here who had great luck with microfracture because they've moved on to an active life. You'll find a greater percentage of people here who have had failed drillings or failed OATs because we are all looking for info.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
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Old 02-18-2010, 08:33 PM   #5
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Re: Ankle OCD in my 13 year old daughter

Hadn't read much of late....had to post though. My 14 y/o was diagnosed with a 10-12mm OCD at age 13 and wound up having a drilling about a year ago. It failed, and last November the surgeon recommend she proceed with an OATS. She's headed into surgery in about 5 weeks.

I know exactly what you mean about disappointment....ours was just shy of a her blackbelt and headed into Volleyball, Basketball and Track. She's still being fairly active these days but with as little-impact as I can coerce her into.

The surgeon who did the drilling (and will be doing the OATS) was optimistic before drilling, but subsequently reported: "oh yes, quite a few fail because the underlying bone is damaged." We did talk to several of his patients who are doing well to very well post OATS.

We're all hoping as hard as we can and laying in supplies for post-surgery life. Crutches, knee walker, cryocuff etc, etc...

I will say that we checked out several surgeons fairly carefully. The one we settled on had done a number of drillings on early teen-age kids. Get a good second/third opinion.

If I'd done more research before my daughter's failed drilling, I might have considered pushing for an OATS then, in the intervening year, the lesion's grown a bit.

Good luck!

 
Old 02-19-2010, 08:12 AM   #6
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Re: Ankle OCD in my 13 year old daughter

Nonsuch01,

Let your daughter know that I got my black belt and 1st degree after my drilling and then went on to get my 2nd degree later after my OATs. And, I'm 41, not a young teen. So don't let her give up on her BB dream. I had to adjust some things, and my speed wasn't quite the same, but it can be done.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 02-24-2010, 02:40 PM   #7
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Re: Ankle OCD in my 13 year old daughter

I believe that the large problem with the unsuccessful treatments of cartilage repair (or as some have called it OCD) is that the cell density in cartilage decreases significantly once you reach age 12. I have also suffered from cartilage damage and suffered with the pain. I have done a significant amount of research to date before I go through with surgery and came across a new procedure (its called Denovo NT, from a company called Zimmer) that implants juvenile cartilaginous allograft tissue into the defect which has 10x the cell density of adult tissue. This not only provides relief because the defect is filled, it also implants living cartilage tissue which continues to integrate into the bone beneath the defect. Im not a pro on this stuff but I have an appointment to speak to a surgeon that is using it.
Hope this provides another alternative to the otherwise unsuccessful options out there

 
Old 02-25-2010, 04:42 AM   #8
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Re: Ankle OCD in my 13 year old daughter

My dr. is also talking about using the same procedure with the minced cartilage. I'm in limbo waiting to hear about it though right now. Please post anything you know as Patti, who is also on this board is also considering the procedure.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 02-25-2010, 10:25 PM   #9
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Re: Ankle OCD in my 13 year old daughter

Thanks to all for your responses re. my daughter's situation. We see another surgeon on Wednesday and then will decide about drilling.

 
Old 02-26-2010, 07:00 AM   #10
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Re: Ankle OCD in my 13 year old daughter

From what I understand it is a fairly new procedure, studies go back 2 years so far. There have been over 1200 procedures to date and the success rate has been very high. It is similar to ACI but in ACI is very expensive (in excess of 20k) and ACI uses your own cartilage which, as i mentioned in my previous post, has about a 10x lower amount of cell density once you reach around age 13. Another advantage is that it is showing to reproduce hyaline cartilage, which is the cartilage that takes the load of joints. Drilling or microfracture surgery is shown to produce fibrocartilage which doesn't have the smooth gliding texture. My thoughts are if I can have a living juvenile cartilage implanted and studies have shown that cartilage from juveniles (less than 12) is shown to have 10x the amount of viable cells to reproduce hyaline cartilage, then why would I want them to drill and risk my own cells not have the strength to grow viable hyaline cartilage. I would google Denovo NT and see what you can come up. I will also see if there are any papers out there, also ask your doctor. There is nothing like this on the market and this is where you will start to see a lot of the procedure go to. Its less invasive and less traumatic to your bone.

 
Old 03-30-2011, 11:54 AM   #11
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Re: Ankle OCD in my 13 year old daughter

I am very interested to hear how everything went with your daughter. I have a 13 year old son in a very similar situation. Doctor is recommending drilling but I really don't want to see him go through this if the odds are that he will have to have the OATS procedure performed at a later date. Jill

 
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