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.
His right ankle is painful and he wants to be active and do sports again. He has limited ROM in dorsal extension.
Right ankle: swelling, dorsal extension limited 10 degree, plantar flexion is normal. No instability. The alignment is good.
[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.
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.
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.