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.
Current complaints:
Posteromedial and anterolateral handfoot pain. Instability.
Physical examination:
Posteromedial and anterolateral handfoot tenderness. Anterior draw lax but does not reliably reproduce symptoms.
Radiology:
X-ray:
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.
Images:
Case summary:
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?
Expert:
Looks like cystic lesions in the PTT sliding channel. It is best to open the PTT grove and create a smooth groove after debridement.