Description of patient (type of occupation, indication of age, intensity of sport):
44 years old. 8 months post twisting injury, likely supination. Otherwise well.
History and previous treatment:
Initial treatment was non operative with physiotherapy.
Posteromedial and anterolateral handfoot pain. Instability.
Posteromedial and anterolateral handfoot tenderness. Anterior draw lax but does not reliably reproduce symptoms.
MRI and CT done. anterolateral impinging soft tissue. Medial malleolus bony oedema with post traumatic cysts. Small lesion on medial talus.
Additional investigation (CT/MRI):
[Picture 1 -3]
Significant fibrosis ATFL and CFL. No significant fibrotic change at the PTFL which also had undergone strain at the time of the original injury. Significant ongoing swelling at the MCL - deltoid ligament complex. Evidence of early degenerative change tibial plafond laterally and bony reactive oedema medial malleolus.
44 years old with medial and lateral pain 8 months post supination injury. complains of instability.
Question(s) to this case:
I am considering arthroscopy and lateral ligament reconstruction (open). I am concerned about the medial sided changes and whether they can be addressed arthroscopically. I am also concerned that her laxity does not reproduce her symptoms. should the medial sided lesions be addressed arthroscopically?
Looks like cystic lesions in the PTT sliding channel. It is best to open the PTT grove and create a smooth groove after debridement.