Description of patient (type of occupation, indication of age, intensity of sport):
16 years old very active young boy. Main sport surfing.
History and previous treatment:
2 years ago ankle inversion trauma. Treated conservatively. No complains till 10 months ago started deep ankle pain.
Current complaints:
Deep ankle pain. Located more posterior part of ankle joint. Not able to walk or surf. Running is also not possible.
Physical examination:
No visible deformations around the ankle joint. Plantar and dorsalflextion free. No restrictions, but painfull in maximum plantarflextion.
Radiology:
X-rays - no visiable changes
OCD lesion in posterior tibial side in MRI study. Size 1,4x0,8x0.4
OCD lesion in same location on size.
Images:
Case summary:
16 years old young very sportive boy with deep left ankle pain (posterior tibial OCD lesion) and restriction in daily and sportlife.
Question(s) to this case:
What is the solution in this case?
Expert:
Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. In my experience these lesions have a good healing potential without developing a loose body. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Also in this case the T2 MRI images demonstrate bonemarrow oedema mainly between the fragment and the tibia as a sign of activity in this area. This is a sign of new bone formation between the fragment and the tibia. On the 6 CT slices you can nicely see new bone formation between the fragment and the tibia as a sign of healing. I believe you should stay conservative and wait for the integration of the fragment and tibia. It might take another 3 month. In case of persisting pain you could perform retrograde drilling in order to stimulate the healing of the fragment. Another approach is posterior ankle arthroscopy with inspection of the cartilage and removal of any detached cartilage. Remove as few cartilage as possible. Bone marrow stimulation in the area were you needed to remove detached cartilage.
Please sent me the evolution of this case