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.
Current complaints:
Pain when uses high heeled shoes. Limitation of plantar flexion on the left ankle.
Physical examination:
Neutral alignment. Important limitation of the plantar flexion on the left ankle. Negative drawer test.
Radiology:
X-ray:
Talar cystic lesion.
Additional investigation (CT/MRI):
CT: 2 cm posteromedial osteochondral lesion.
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Images:
Case summary:
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?
Expert:
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.