Description of patient (type of occupation, indication of age, intensity of sport):
Female, 67 years old.
History and previous treatment:
She describes a previous history of ankle sprains. No treatment has been attempted yet.
Current complaints:
Deep left ankle pain. The pain has been present for quite a while now.
Physical examination:
Normal range of motion. Negative ankle anterior drawer test. No signs of anterior or posterior ankle impingement.
Radiology:
X-ray:
[Picture 1]
No signs of significant osteoarthrosis. Osteochondral lesion of the distal tibia is visible on the lateral view.
Additional investigation (CT/MRI):
[Picture 2]
CT revealed an osteochondral lesion of the distal tibia.
Images:
Case summary:
This is the case of a 67 year old woman who complains of deep left ankle pain.
Question(s) to this case:
How would you approach this lesion? We are currently considering retrograde drilling or an medializing osteotomy of the calcaneus. Any technical tips regarding retrograde drilling of this lesion?
Expert:
If there is some laxity of the ligaments, then you can approach from the front and use a microvector drill guide (or ACL aiming device) for retrograde drilling. If the ankle is very stable however, I would perform posterior arthroscopy with microfracturing. How is the alignment? If there is valgus then you can consider a medializing calcaneal osteotomy.