Description of patient (type of occupation, indication of age, intensity of sport):
A 13 years old girl presenting with bilateral ankle pain for several years.
History and previous treatment:
No trauma has occurred.
Ankle pain during sports, occasionally with normal walking.
Pain in the anteromedial part of the ankle joint during examination. There is no swelling of the ankle.
X-rays show osteochondral defect on the medial talus bilateral. Defect on left ankle is larger than the right side. The physis is open.
Additional investigation (CT/MRI):
CT and MRI scans show bilateral talar osteochondral lesion
An active 13 years old girl with bilateral medial osteochondral talar defects.
Question(s) to this case:
What is the best treatment option in this case?
Is it advisable to perform arthroscopic surgery with microfracturing (or drilling) of the lesion, or is a conservative treatment because of the very young age favorable?
I tend to be conservative till end of growth. If however you have to perform surgery because conservative is not acceptable then removal of fragment and microfracture is indicated. It should be possible to reach the defect from anterior in forced plantarflexion. In case you are uncertain about that, make a sagital CT in forced plantarflexion for preoperative planning.