Description of patient (type of occupation, indication of age, intensity of sport):
45 year old active female.
History and previous treatment:
Deep medial ankle pain with activity. Mild previous trauma and no previous surgery.
Current complaints:
Pain in the medial ankle.
Physical examination:
Full range of motion- medial malleolus pain and pain over the medial ankle joint. No effusion.
Radiology:
X-ray:
Not available.
Additional investigation (CT/MRI):
MRI- attached- large medial cyst communicating with the joint- medial distal tibia.
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Images:
Case summary:
45 year old female with large tibial OCL and pain with activity. Surgical management?
Question(s) to this case:
How to approach this surgically? Graft from inside, or open cortical window from outside?
Expert:
Cortical window with curetting the cyst and destruction of the cyst wall into bleeding bone followed by a massive autologous bone graft should best be done. Try to identify the opening from the joint to the cyst and curette the entrance.