Description of patient (type of occupation, indication of age, intensity of sport):
Female, 17 years old, sedentary profession.
History and previous treatment:
Insidious pain in the ankle. No trauma.
Pain when uses high heeled shoes. Limitation of plantar flexion on the left ankle.
Neutral alignment. Important limitation of the plantar flexion on the left ankle. Negative drawer test.
Talar cystic lesion.
Additional investigation (CT/MRI):
CT: 2 cm posteromedial osteochondral lesion.
[Picture 1 -3]
Talar cystic lesion in a 17 years old female patient.
Question(s) to this case:
The best option is an open procedure or arthroscopic? Anterior or posterior arthroscopy?
Large lesion with secundary cyst below the lesion, which means that the fragment does take a significant part of the load.
My advice is to go for a lift-drill-fill-fix procedure. Leave the fragment and secure it to the talus. If she has no laxity of the ankle ligaments I am afraid the aproach in this case has to be by means of a medial malleolar osteotomy.