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ocd sizes


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Old 05-20-2011, 07:10 PM   #1
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ocd sizes

What size would doctors typically consider a small vs large osteochondral lesion? In the small amount of research I have done, the treatment seems to be based on the size of the lesion. Anyone know?

 
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Old 05-23-2011, 09:48 PM   #2
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Re: ocd sizes

It seems to me that "small" for OCD of the talus is defined as less than than 1 sq.cm (e.g. 10mm x 10mm). "Big" is when total area >100 sq.mm, or where one dimension is >15mm (like 15mm x 6mm). And "really big" is where one dimension is >20mm. Some medical web sites or papers say microfracture has the highest success rate when it's <1sq.cm.

Somewhere between 10mm and 16mm (longest dimension) docs start to recommend graft instead of MF. Somewhere around 20mm and bigger, I think most docs start recommending cadaver graft and/or mosaicplasty over using autograft and/or a single block graft. Location and shape of the lesion might also influence the treatment recommendation. I don't know if a 10x10 mm lesion is treated the same as an 8x12.5 mm lesion, even though both have the same surface area.

Different docs seem to use different definitions. When mine was 6mm x 4mm on the first MRI, it was definitely "small." Now that it's 6x11 or 8x9 or 8x15 (depending who is reading the MRI), they're calling it "good sized" but not yet "large."

Not a very scientific reply, I know.

 
Old 05-24-2011, 04:20 PM   #3
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Re: ocd sizes

That is a great response. Just what I was looking for, thank you!

If you don't mind me asking, what have you tried in terms of treatment for this OCD? I don't believe these ocds can heal, but the pain can be reduced? Is that correct? Have you had microfracture or any type of surgery done yet? How long of a time was it inbetween your MRIs that the lesion grew that much larger? Thank you for all of your responses to my questions. This is a completely new area of ankle problems for me that I am just beginning to research.

 
Old 05-24-2011, 05:20 PM   #4
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Re: ocd sizes

My "conservative treatment" hasn't been very scientific or rigorous (conservative treatment often includes a boot and period of NWB). After first MRI I switched from occasional running on treadmill to walking on treadmill.

After 2nd MRI switched from walking on treadmill to swimming and using eliptical, plus taking ibuprofen and more recently a calcium supplement (was already taking glucosamine/chondritin supplement). My theory is that impacts make it worse, so in both cases trying to avoid impact without avoiding exercise.

My hope is to stop it from growing. I've never seen any research to indicate calcium or any other supplement can help with talus OCD, but I figured it can't hurt. Planning on 3rd MRI in June. If it's any bigger then I will get surgery, probably try MFx first.
  • mid June 2010: X-ray shows 5mm "ossific fragment" consistent with OCD
  • Late June 2010: MRI shows 4x6 mm focus of OCD
  • March 2011: MRI shows 4.7 x 10.5 x 9 mm OCD (9mm deep)
Technically the MRI shows the abnormal signal around the OCD, not the OCD itself, so the actual OCD can be smaller or larger than what shows on the MRI.

Last edited by LivesNearStore; 05-24-2011 at 05:28 PM. Reason: clarified interpretation of 2nd MRI

 
Old 05-28-2011, 07:04 PM   #5
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Re: ocd sizes

Just re-reading some stuff about OCD on Medscape.
  • Only 4% of OCD lesions are on the talus (guess the rest are on knees and elbows)
  • Generally 4 sq.cm (e.g. 20mm x 20mm) is considered the limit for doing OATS/mosaicplasty with a reasonable chance of successful outcome
  • However mosaicplasty has been done on OCD lesions as large as 8.5 sq.cm (that's like 29mm x 29mm)

 
Old 05-29-2011, 11:19 AM   #6
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Re: ocd sizes

Thanks for that additional information. Glad mine is considered small at this point. I will be curious to hear about what happens with your upcoming MRI in June.

 
Old 07-19-2011, 05:50 PM   #7
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Re: ocd sizes

Poppyg1: I have to revise my definition of what is a "large" OCD. In reading the literature, some papers define size by maximum length or diameter (in mm), and others measure the total area (square mm or square cm). For length or radius, what I wrote earlier remains true--small is generally defined as <10mm or so. But if you talk about area, it seems that small is usually defined as <25 sq.mm, which is a 5x5mm square or a 5.64mm diameter circle.

To confuse things, some papers say things like "Best results for procedure X in this study were obtained for lesions smaller than 2.5 square cm." To me, one square cm is 10x10mm or 100 sq.mm, so 2.5 square cm is 250sq.mm. However, since one cm=10mm, it's possible some papers wrote 2.5 sq.cm but meant 25 sq.mm (2.5 * 10 = 25).

In the end my OCD was between 6x7 and 6x9mm which is 42-54 sq.mm. It was slightly smaller than it appeared on the last MRI. In diameter mine isn't so big because longest dimension is <10mm, but in area my lesion was medium because it's bigger than 25 sq.mm. Hope that doesn't muddy things up too much.

 
Old 07-19-2011, 08:27 PM   #8
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Re: ocd sizes

LivesNearCostco-

Very interesting and good information. 25 sq. mm seems so small to me. My lesion is measuring 6x8 on my MRI. I don't think I have even seen anyone with something smaller than that on these boards. Obviously, I am sure they are out there.

I just wish there was more of a concrete plan of the treatments based upon the size of the lesion. Everything seems so up in the air with this diagnosis, I find it very frustrating. I understand that medical outcomes are never guaranteed, but I think problems that have more of a definitive solution can be easier to deal with (for me at least). It is much easier to make a decision when there really isn't a decision to make. Such as, unstable ankle= brostrom in majority of cases.

Thank you for taking the time to update this information. Hope your healing is going well!

 
Old 07-20-2011, 05:16 AM   #9
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Re: ocd sizes

Hi Poppyg1,
My OCD lesion was 4mmx6mm on the anterior-lateral aspect of my talus. I had microfracture done in 2/2009 for that (and I had some other issues in that ankle too). I am currently recovering from ankle impingement surgery that I had 2.5 months ago. My OCD lesion has completely filled in but I had a ton of scar tissue build up.

It is my understanding that although size does matter it isn't the "tell all." Any sized talar dome OCD lesion can cause significant pain, immobility, and lead to further problems down the road.

Julie

 
Old 07-20-2011, 07:02 AM   #10
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Re: ocd sizes

Julie-

Thanks for taking the time to respond. Is the pain from your OCD gone? I had an arthroscopy for soft tissue impingement along with a brostrom in November. That was the second surgery I had for impingement. I am starting to think that all along maybe it is the OCD causing the pain. For some reason, my OCD has just recently been discovered about 2 months ago, after I have already undergone 2 surgeries since my initial injury. I have also read that some people will have very large lesions and very little pain, as well as the vice versa.

Thanks Again

 
Old 07-20-2011, 07:44 AM   #11
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Re: ocd sizes

I don't know if the pain from my OCD lesion is gone or not as I'm still dealing with post surgical recovery pain. I never felt right after my first microfracture though. (That particular ortho suregon did not specialize in ankles...he didn't exactly do a good job within my entire ankle). So, I can't really answer your question. I will say that up to my biking incident last Sunday, this recent ankle surgery has made a HUGE difference in how my ankle feels. It is/was the BEST it has EVER felt. It's a different story now though (after biking on Sunday...I think I overdid it....and I'm still early in my recovery from this surgery).

I do know that OCD's can cause all kinds of strange and PAINFUL pains throughout the ankle and radiate into the midfoot, etc. What was your original injury? What type of pain are you having now?

 
Old 07-20-2011, 10:26 AM   #12
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Re: ocd sizes

My original injury was a broken tibia and ruptured syndesmosis (based on MRI and surgery). I had a screw put in for the syndesmosis and an open debridement of the syndesmosis joint. I continued to have the same pinching sharp pain in the front of my ankle joint. So went to a new DR once the first one gave up and said he wasn't really sure what the problem was now. The new doctor said I was having impingement and needed a brostrom for lateral instability. My ankle feels so solid now which is nice, but I am still having the same sharp stabbing pinching pain that I have had since my initial injury.

I remember when I was in PT after my brostrom/scope asking the therapist if I should be concerned that the pain was still there. She thought it was too early to tell, but a couple weeks later when it was still there she voiced her concerns to me. I just feel like I have had these surgeries that didn't even fix what has been causing me the most pain all along. Granted, my symptoms did and do match that of impingement, (pain with going down stairs, squatting, etc.) but after the second surgery when it was still there, it obviously wasn't impingement (seeing as it came back both times after surgery, and there wasn't even that much synovitis the second time). My pain seems to be getting worse. I am not sure if I am trying to do more or if it is just getting worse. I can't even imagine jogging or running and I am unable to ride my bike or do anything along those lines. Luckily, I have taken up yoga which has been wonderful to be able to do something physical. I was a D1 college athlete so going from that to doing nothing has been awful. I know I am not the only one in this position, but its just very frustrating.

My most recent MRI said the lesion is anterior in the joint which is where I have been feeling the pain all along. I understand most lesions are either posterior medial or in the anterior lateral corner. I am hoping because I have been feeling pain across the anterior joint line, that this is what is causing my problem.

Sorry this post is so lengthy!! Thanks for all of your help.

 
Old 07-20-2011, 12:13 PM   #13
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Re: ocd sizes

Hi again,
I completely understand about going from being an athlete to doing nothing. I was a competitive inline skater, ran, biked, hiked, yadayayda. I had both of my knees replaced last year and am still dealing with my ankle. Anyway...I am glad that you have found some type of movement that helps you feel alive!

I will never run again, which I'm am finally OK with. I tried skating after my first ankle surgery but that was CRAZY painful and my knees at that point were shot.

My current ankle OS gave me the OK to try skating again but after my experience with my biking on Sunday, I will hold off on that a while. He also told me that squatting is totally out of the picture for me b/c it puts too much load on the ankle joint (and it puts a lot of stress on the patella femoral joint, the compartment that I got replaced in my knees).

My OS and I were discussing different yoga/core moves for me to perform. I love doing plank holds, etc but b/c that also puts a lot of load on the ankle joint my ankle OS advised me NOT to do those at this time. I would think that some of the yoga poses would add to your anterior ankle joint pain..warrior, downward dog? Just a thought.

Have you had an MRI arthrogram (where they inject dye into the joint)? That will give your OS a very clear picture of your joint (even though it sounds like you have it figured out). Do you think you'll go through with the drilling? Hang in there.

Last edited by let me walk; 07-20-2011 at 12:15 PM.

 
Old 07-20-2011, 01:36 PM   #14
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Re: ocd sizes

In terms of the yoga, lucky for me I found a great studio and instructor through one of my friends. She is a physical therapist so understands my problem pretty well. She has been wonderful at offering me modifications. For example, when we do planks, I just do them on my knees. If I have pain with things, then I just simply don't do them. I have also been able to adjust myself in certain poses to avoid sharp pain.

I haven't had the MRI arthrogram. Perhaps I can ask if that would be helpful in being sure about the next step. I am currently trying a bone stimulator to see if that will help any. I have about another month to go, then if that doesn't work, I will proceed with drilling. I need to do something, but am dreading another surgery as well as dealing with my work and telling them I need more time off. I may have to wait until November to become eligible for my FMLA again.

Wow! Both knees replaced and ankle surgery. Seems like you are doing well other than the recent pain you have experienced. Lets hope that your OCD is healing well.

 
Old 07-28-2011, 02:08 PM   #15
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Re: ocd sizes

Hey Poppyg1. I used to skate a bit (inline and ice) but can't comment on the yoga or running. Am swimming again but not allowed to kick with the right foot yet, so my arms get tired quickly. Note that OCD lessions often appear bigger on the MRI because the MRI captures inflamation/edema around the lesion. However if you had a CT, I'm guessing it's exactly as big as it looks on the CT.

If you're interested, I posted photos of my actual OCD in my thread, so you can see how it was sized during the scoping. The only thing is I'm not sure if my doc took the sizing photos before or after debriding the bad cartilage. If the photos he gave me were all taken in order, it was after debridement but before microfracture.

Warning: not for the squeamish. One photo shows blood.
http://www.healthboards.com/boards/showthread.php?t=847979&page=7

Last edited by LivesNearStore; 07-28-2011 at 02:18 PM.

 
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