Hi,
I was in a MVA accident last Sept. 2006 and suffered a broken femur and some other injuries. Started rehab at the end of the Jan and voiced concerns over my ankle. Returned to work this Oct. but ankle was still quite painful especially walking on hard surfaces, doing stairs and turning. Nobody at my work would believe me, the OHN basically called me a liar saying she had seen me walking and that I wasn't limping therefore I was not experiencing any pain. Got results today from MRI, here's what it says, "There is a small joint effusion present. There is bone marrow edema seen in the anterior distal tibia plafond with some high signal posteriorly as well. There is also high signal in several locales involving the talar dome. The anterior inferior tibiofibular ligamnet appears intact. The anterior talofibular ligament is also intact". Here's the radiologists impression, " Small ankle joint effusion. Bone marrow edema in the distal tibia plafond anteriorly and posteriorly with several areas of bone marrow edema involving the talar dome particularly laterally. The appearance are compatible with an osteochondral injury. There is no MRI evidence of ligamentous disruptions involving the lateral ankle."
What does this mean? What do I expect for recovery time, if surgery is needed?
Thanks Tonloc

Howdy and welcome.

Darn, a year out on an osteochondral lesion is a long time.

An osteochondral lesion, often called an OCD, can be compared to the kind of injury that an apple sustains when it falls off the shelf. The skin remains intact but the pulp is compressed and damaged. So when you pick up the apple you can see and fee a defect in the pulp. That's what the MRI is seeing in the bone adjacent to the ankle.

Did you get a chance to talk to your doctor about it at all?

Jeff

No, I have an appointment on Thursday, where we will get an opportuntity to look at the films and he can shed some light on the injury. Based on the readiologist's report, in your best profesional opinion what does the future hold for me. My current job requires me to stand and walk for long periods of time on a concrete surface. My tolerance for that is probably 15-25 mins initially and the more frequent the walking the shorter the duration.
Any educated and professional opinion at this point in time is greatly appreciated.
Thanks in advance Tony

Just a little more infor for you, I already have tried ultrasound,laser and accupuncture on the affected ankle and nothing seems to have worked. This injury was not diagnosed until the end of June which was a couple of months after I resumed walking without any aids and at that time the OS believd it was a strain of the ATFL. Both the OS and PT said that the swelling was due from fluid draining down from the femur trauma area. I did wear an orthopedic brace for a period of time but only if it required me to be standing or walking for 2-3 hours. Am I to assume that I'm past the first stage and that surgery would be required. I am unable to return to preaccident lifestyle, not unable to golf, run, jog ar even for that matter sustain walking for any duration. The MVA was a head collision with a dump truck. At the time of the accident my left foot was on the foot rest and I wasn't wearing any footwear. The femur was broken in 3 places and I've an IM nail in my femur.

Howdy,

Hard to say. I'm never overly optimistic about OCD's. But a bit part of the prognosis depends upon the size of the lesion. The smaller the lesion the better. Also, the location in the ankle matters. I tend to find that posterior medial lesion heal less that anterior lateral lesions. So when you go over the films, peg the location.

My guess would be that you're in line for an arthroscopic debridement of the ankle. That'd enable your doc to take a first hand look-see at the ankle and clean things up a bit while in there.

Jeff

Dr. Oster,
Thanks you for your input so far, just a followup to our last converstaion. My OS has referred me to a foot and ankle specialist and I am waiting the consult which is scheduled for Feb.19. The OCD is in the talar dome mostly in the lateral aspect as well as some corresponding changes in the tibial side of the joint. OS unable to give me the size but he feels that its somwhere in the 10-20 MM range but he has no reference point. Has of Dec. 06 he has put me off work indefinately and the last couple of weeks the frequency of pain has increased and I've resorted back to using a cane. Do you think that I should be NWB? The pain now even bothers me nightime and I've resulted back to taking some pain medication. Will I cause any more damage if I continue to try to walk with a cane or without? I hope my the end of the week I can get you the MRI results of the ankle so you can have a look at them yourself. My work is pushing me to go back to work even though my family doctor and my OS has said that any return to work plan would not be good for me. no matter how carefully crafted. My current job enatails standing for long periods of time on concrete and wearing steel toed boots. I personally don't feel it's in my best inteerst to return to work until the consult because we are already 16 months out past the initial accident and I don't wish to jeopardize my well being for the sake of my employer. I won't get into the issues with my employer but to say the least they have been very difficult to deal with. My MRI was scheduled for the Nov.26, on the 29th they put me back on the floor not willing to wait for the results which were due by Dec.11, needless to say I was not impressed.
Thanks Tony

Hi Tony,

No, you ought to be OK bearing weight on it, but you do need to listen to the symptoms. The pain that you're getting is the best gauge as to your problem. Mother nature is trying to tell you something. I heard it said that pain is a gift...I'm not sure you'd agree, but I think you see the point.

The MRI ought to be able to give you both the stage and size of the lesion. One thing in your favor is the fact that lateral lesion are easier to fix than would be a medial lesion. Lateral lesions are usually in the front of the ankle. They're easier to get to to fix and do tend to have a little bit better track record of healing.

Jeff

Dr. Oster,
Can I send you some of my MRI results, maybe you can shed some light on the severity and size.
Thanks Tony aka Tonloc

Dr. Oster,
I have forwarded some films from my MRI to your email address. If you need a different view, I do have those pictures as well.
Thanks Tonloc

Hi,

I didn't get you images. Best to post them here in the forum. If you click on the red 'ubb code is enabled' to the left, there'll be instructions on how to post images.

Jeff