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.
Deep left ankle pain. The pain has been present for quite a while now.
Normal range of motion. Negative ankle anterior drawer test. No signs of anterior or posterior ankle impingement.
No signs of significant osteoarthrosis. Osteochondral lesion of the distal tibia is visible on the lateral view.
Additional investigation (CT/MRI):
CT revealed an osteochondral lesion of the distal tibia.
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?
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.