Description of patient (type of occupation, indication of age, intensity of sport):
28 years old and sportive patient
History and previous treatment:
AS BG (ligament repair) for ankle instability
Deep left ankle pain during sport and axial bearing/load on left ankle and swelling.
well aligned hindfoot valgus 5°. Stable ankle (talar tilt and drawer test negative), F/e 40-0-10
Additional investigation (CT/MRI):
[Picture 1, 2 + 3]
CT/MRI: medial OCD 10x10x6 mm. Cartilage lesion on 6 mm.
Symptomatic medial talar OCD 10x10x6 mm.
Question(s) to this case:
What is the best treatment option?
1: Anterior AS, debridment and mircofracture
Do you think that I need do feel the lesion with graft (spongious graft from proximal tibia) or not (no graft)
2: DFF (the cartilage lesion seems to be too small to be fix?
3: Retrograde drilling?
I think that debridment and mircofracture with graft will be a good option (but there is a risk of puting some graft in the joint space leading to a "loose body")
The roof of the cyst has been "broken" (see sagittal CT). Retrograde drilling is not a good option since it will not make the fracture heal.
I would go for debridement and BMS. Question then is to fill or not to fill.
If not then you can go with anterior arthroscopic approach. Chance of failure then is somewhat higher when compared to a smaller lesion.
In case of filling with a graft I would go with an open anteromedial approach. The joint nicely opens up in the front as seen by the CT in max plantar flexion. You will be able to reach the defect debride and fill it. I would do the latter