Description of patient (type of occupation, indication of age, intensity of sport):
19 years old male hockey player.
History and previous treatment:
none
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.
Radiology:
X-ray:
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]
Images:
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?
Expert:
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.