0:00

The history on this one was a 47 year old complaining of lateral ankle

0:05

pain radiating up to the lower leg. So in this case,

0:10

uh, we have a, a,

0:12

a nice case of an osteochondral injury, or,

0:15

or OCD or OCL, uh, osteo, chondra,

0:20

desican, dessicans, whatever you and your, um, uh,

0:23

clinicians and at your institution use. Um,

0:28

but we see here that, uh, there is,

0:34

okay, this, uh, um,

0:39

osteochondral injury at the medial Taylor Dome,

0:42

probably more centrally or midline. Okay? Uh, and,

0:47

uh, what I wanna point out with this, uh, OCD or OCL, okay,

0:52

that there is fluid undercutting about this, uh,

0:55

two centimeter lesion within the, uh, lesion, uh, bed.

1:00

So when, if you read the literature, uh, there are various terms, okay?

1:05

I've heard of, um, you know, uh, bone fragments, uh,

1:10

you know, progeny, uh, lesion bed, things like that. Um,

1:15

but again, I would highly recommend just talking and communicating, have a,

1:20

uh, open dialogue with your referring clinicians just so that we, uh,

1:24

that you're describing accurately for, uh, for them if, uh,

1:29

particularly if surgery is being planned. The important thing with these OCDs,

1:34

okay, or osteo OCLs, okay, is the, the,

1:39

not only the size, but characteristics of instability, okay?

1:43

And the signs that I, uh, that have been written in the literature,

1:46

particularly by, uh, the Dr. Deme out of, uh, Wisconsin and others,

1:51

okay? Some things to look for besides obviously, um,

1:57

the fragment being displaced out, uh,

2:00

of the bone lesion or lesion bed. Okay? Um,

2:05

that's obviously gonna be unstable.

2:07

Other things you wanna look for are fluid bright, okay? Fluid bright,

2:11

uh, okay. But if it's not fluid bright, uh,

2:17

it can be, uh, depending on who you read, it's been described as, uh,

2:21

healing or fiber. Gran, uh, fiber, uh, uh, fibrous the sort of,

2:26

uh, granulation tissue, okay? If you're not sure, and you're just, uh,

2:30

making the call, uh, of possible instability off of, uh,

2:35

a non-contrast, Mr. Let's say,

2:37

you can always recommend that the patient gets an, uh, uh,

2:41

an arthrogram CT or, or, or a MR and prove that,

2:46

uh, you know, there is contrast, bright fluid undercutting that, uh,

2:51

the progeny and, and into that lesion bed there, okay?

2:55

Other tips that, uh, or other, other signs that

2:58

You may be dealing with an unstable lesion, okay? Is, uh, sclerosis,

3:04

uh, disruption, uh, or,

3:06

and defects within the overlying articular cartilage, right?

3:10

Sclerosis, uh, multiple cysts or, uh,

3:13

or cyst larger than five millimeters. So,

3:17

so those are some of the things that,

3:18

that have been described in the literature for these, uh, um, OCDs.

3:23

Another thing that, uh, for those that, uh, uh,

3:27

want to read and study more and can be confusing, um, that you may encounter,

3:32

uh, in the literature, okay, is, uh,

3:34

discussion about contained or uncontained lesions,

3:39

or that is, um, uh,

3:43

shouldered or un shouldered lesions. Okay? So it, it can be confusion,

3:48

uh, but basically a sh uh, a shouldered lesion, okay?

3:53

Or that is an, uh, an uncon a shoulder, as I understand,

3:57

is also known as an uncontained lesion, okay?

4:00

A non shoulder lesion is, is also known as a contained lesion,

4:05

okay? But the whole point of that is if,

4:08

if the OCD lesion involves the rounded

4:13

aspect, okay, of the tailored dome or tailored body,

4:18

and particularly cuts down in onto the vertical side of the tailored body,

4:24

those, those, um,

4:26

uncontained or shoulder lesions are more difficult to treat, um,

4:31

by our podiatrist and orthopedic foot surgeons. Okay?

4:35

It's already a tight spaced, uh, as I, as I am told, um,

4:40

and taught, uh, that it's already difficult to get in there.

4:43

So you can imagine if it's involving that, uh,

4:47

rounded aspect or that vertical aspect of the tailored body, it's,

4:51

it's even harder as, as I understand it, okay? So not, so that's another,

4:56

uh, important thing to mention, uh, in your, uh, in the report besides,

5:01

uh, mentioning that it could be a, a unstable or, or a stable lesion.

5:05

So in this case, um,

5:08

this arguably is probably maybe cutting down or involving that rounded

5:13

aspect or that shouldering and cutting down to the vertical aspect of that Alis,

5:18

which, which, uh, articulates with the medial mallis, obviously. So this may be,

5:23

uh, a more difficult, uh, lesion for our, for our surgeons to deal with,

5:28

um, in this unstable and, uh,

5:32

uncontained shoulder lesion. And for those that are interested,

5:36

I believe, uh, if you look up Dr. Choi et al,

5:40

and I believe the articles from a, uh,

5:43

American Journal of Sports Medicine back in,

5:46

I wanna say 2013 or 2012,

5:49

and I can try to dig up the article and send it to y'all as well. Um, but that,

5:54

that's a nice discussion. And if you just

5:56

Look at the, uh, the few figures provided in that article,

6:01

uh, it ni it high, it,

6:04

it displays nicely what they're talking about by an uncontained and contained or

6:08

shouldered and un shouldered lesions. 'cause that can be confusing at times,

6:12

at least for me.