Description of patient (type of occupation, indication of age, intensity of sport):
Athletic female 13 Y - scholar
History and previous treatment:
Spontaneous onset mechanical deep seated ankle pain.
Unable to compete in sport.
No swelling, locking, instability or inflammatory background.
Current complaints:
Mechanical pain.
Physical examination:
Pain with extreme range of motion.
Radiology:
MRI
Xray - only imaging available
OCD both talus
Images:
Case summary:
13 year old girl with spontaneous onset mechanical, deep seated pain both ankle joints
OCD talus on MRI - poor response to rest and physiotherapy.
Question(s) to this case:
Do I offer bilateral ankle arthroscopic micro fractures ?
Expert:
Young girl 13 Y, bilateral medial talar OCD on MRI. Treatment depends on a number of things:
1. Are both ankles symptomatic? Only treat symptomatic ankle
2. Biological activity of the OCD. No Bone marrow oedema on T2, is an important indication that the OCD is not the cause of the pain. Both MRI seem to demonstrate some bone marrow oedema
3. Size of the lesion. Both lesions seem to be larger then 15 mm. Larger lesions should best be treated with fixation (LDFF procedure).
4. In young patients: try to stay conservative since a lot of these lesions become asymptomatic over time or diminish in size.
In summary be cautious to operate and if you decide to do so (active lesion on MRI and patient which demands treatment) make a CT scan for preop planning (size of lesion and aproach) I expect these lesions can be treated by means of open anteromedial aproach (ankle in forced plantar flexion) Lift, drill, fill and fix by means of headless compression screws or resorbable screws depending on your preference.