OCD talus

Osteochondral Defects

Description of patient (type of occupation, indication of age, intensity of sport):

19 years old male hockey player.

History and previous treatment:


Current complaints:

During sports and long walking : anterior and deep ankle pain and sometimes "blocking" of motion in the left ankle.

Physical examination:

Normal ROM of the tibiotalar joint, slight tenderness anterior and slight swelling of the tibiotalar joint.


Flattening of the medial talar dome.
[Picture 1]

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.
[Picture 5]


Case summary:

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.