Description of patient (type of occupation, indication of age, intensity of sport):
19 years old male hockey player.
History and previous treatment:
During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle.
Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint.
Flattening of the medial talar dome.
Additional investigation (CT/MRI):
CT with flexion of the ankle : osteochondral defect of the anteromedial and centromedial talar dome with cyst formation on the anterior side, 2.2cm anteroposterior size and 14mm mediolateral size. Small talar beaking.
[Picture 2, 3 + 4]
MRI : OCD of the talus with loose bone fragment and bone oedema in the talar body. Synovitis of the tibiotalar and subtalar joint.
19 years old male hockey player with osteochondral lesion of the talar dome.
Question(s) to this case:
1. treatment? arthroscopic debridement and drilling? Other?
2. postoperative treatment regime? Period of non-weight bearing since this is a big lesion?
I would go for a lift-drill-fill-fix procedure. This can be done without a medial malleolar osteotomy. The fragment is large enough to fix. Open the cyst anterior and fill it with bonegraft. Fixation with a headless compression screw or absorbable screw.