Description of patient (type of occupation, indication of age, intensity of sport):
A 35 year old patient. He is otherwise healthy.
History and previous treatment:
History of two operations with open bone spur removals of his right ankle.
Current complaints:
His right ankle is painful and he wants to be active and do sports again. He has limited ROM in dorsal extension.
Physical examination:
Right ankle: swelling, dorsal extension limited 10 degree, plantar flexion is normal. No instability. The alignment is good.
Radiology:
X-ray:
[Picture 1 + 2]
Right ankle X-rays show a normal joint space.
Additional investigation (CT/MRI):
[Picture 3 + 4]
Right ankle MRI shows cartilage loss in the anterior third of the talus, bone marrow edema and subchondral cysts in the tibia.
Images:
Case summary:
Early ankle osteoarthritis in the right ankle in a young patient.
Question(s) to this case:
The patient wants to do sports again. Is there a chance for cartilage repair like MaioRegen or Hemicap Implantation in the main weight bearing area? Patient was offered HA injections. He wants a permanent solution.
Expert:
The treatment depends on the complaints. If there is recognisable anterior tenderness on palpation then an arthroscopic debridement still can be considered. If there is only deep ankle pain then I am afraid there is no good surgical solution. There is a kissing lesion meaning early osteoarthritis. I would first go for HA injections. If HA injections fail then make a standing X-ray to judge if a sliding calcaneal osteotomy would be an option.