Dr. Says I need ankle surgery but the MRI results don't seem bad, any orthopedic docs that can translate?

Question

I went into my ortho Dr.'s office with complaints in my left ankle when I first wake up & going up hills with swelling involved near my old ankle stabilization scar from 2001. The MRI showed "a spur projecting off the anterior article surface of the tibia, with some associated marrow edema. Findings consistent with anterior impingement, no evidence of associated edema involving the talus, or associated joint body". "Ligaments: Marked thickening & irregular of the anterior talofibular ligament, the talar as well as the fibular attachments now remain intact, small joint effusion present." Extensor & flexor long tendons all appear intact, no evidence of tendonitis, tenosynovitis or a tendon tear".
So, this doesn't seem that bad to the untrained eye, why does my Dr. want to drill a hole in my bone & loop my tendon through it? I have a second opinion scheduled for tomorrow, but I would like to be knowledgeable when talking to the new Dr., we are talking about crutches for 2 months.

Answer 1

Reading your MRI report, I believe some of your pain is likely due to the spur off your tibia. Why? Because with first step in the morning and going up hills is where you get the most pain and that spur on the anterior part of your ankle is the one getting impinged. When you go up hills, the ankle is dorsiflexed (moved up) causing the front of your ankle to get trapped and the spur is hitting the the bone underneath it. If it were me, I would not suggest drilling a hole to recreate your ligaments because that's not what you need. You just need to clean up the front of the ankle which will relieve a lot of your pain and you can do that either open or through an ankle scope. Plus, you won't need to be on crutched for 2 months - you actually can be walking after surgery with a walking boot. Hope this info can help with your 2nd opinion visit!

Answer 2

You are under the mis-impression that a licensed orthopedic surgeon is going to come to Yahoo Answers to give free diagnoses to people. That's not realistic. It would put them at risk for a liability suit if they did so. They have to give their time to paying customers, not spend their time hunting for people to give free advice to.

Having worked as a medical office manager in the past I can give you some tidbits, but you could have found my info by google searching or doing a medline search.

A spur is like a little knife, projecting out from the bone. Such a spur has the ability to cause injury to ligaments and tissue that it stabs as you move.
Marrow edema refers to swelling of the marrow area, which is a sign of infection.
Thickening of the ligaments means they are thicker than usual. This could come from a variety of sources, but they should not be thick, and it indicates something has bothered the ligaments.
Small joint effusion means there's liquid in that joint. this should not be there.
The GOOD news is that your tendons appear to be in good condition. The problem is mainly with the spur and the ligaments.

When you get your second opinion, which is what I was going to suggest, ask the doctor to point to each item in the original diagnosis and point it out to you and explain in terms you can understand (like orthopedics for idiots) what each part means.

You should ask the first doctor WHY he thinks it's needed to drill a hole in your bone and looop your tendon through it. Don't ask anyone else but the doctor who made that recommendation the question of WHY; NOONE can validly answer for him.

When you go to an orthopedist, you don't need to sound like you're already an "expert" on your condition. You're better off if you say, "I really don't understand, and I'd appreciate it if you'd give me an explanation in really simple layman's terms so I can understand what you think is wrong and what you think should be done to my ankle." If you try to become an expert before you see the doctor, you might make the mistake of trying to tell him how to do his business, and that never works out well.

SO WHAT! if you're on crutches for 2 months? My son had 3 major orthopedic surgeries and was bedridden for 2-3 months before he could even get up with braces and crutches.

Just make sure you have someone patient and caring to help you through the recovery. Getting places when on crutches is a real pain. Even going to the bathroom is not easy for a man.
BUT
your feet support all your body and you need to take proper care of them, and if you don't you'll be off your feet for a lot longer than 2 months!!!

Answer 3

*taking about surgery as you described it with a hole in the bone and a loop of tendon is usually for unstable joints , may be in the inferior tibio-fibular joint , and to diagnose this instability is by clinical exam. and imaging usually with stress on the joint .
*the above description of the MRI result did not exclude this diagnosis , and this procedure usually used for chronic symptomatic instability , witch arise its self sometimes only as pain and swelling .
my advice is to discuss your doctor and for sure he will not push you to un needed surgery .

Answer 4

He is a doctor. You should trust him to do what is best for you as a patient. If for some reason you really don't trust what he is telling you then just get a second opinon and see where that takes you.