Picture of the week

On this page you find the collection of the most interesting Pictures of the Week which were send over the years to members of Ankle Platform. They present an interesting case, operative technique or a technical tip or trick. They contain useful information for daily practice.

Members of Ankle Platform receive regularly a new Picture of the Week with an interesting case, operative technique or a technical tip or trick. They contain useful information for daily practice.

Bone infarct of the talus with subchondral fracture

A 59-years old male patient presented with weight-bearing induced pain in the right ankle during one year. He has a history of alcohol abuse with polyneuropathy, nicotine abuse, diabetes, osteoporosis...

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Loose Bodies - Composition by Eric Vloeimans

'Loose Bodies' is the First Orthopedic Composition. The world premiere was in The Scheepvaartmuseum in Amsterdam on May 23, 2014 during the biennial ESSKA Congress. From orthopedic perspective a ...

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AMI view: a 3D animation

The AMI view is designed to disclose medially located osteophytes in the ankle joint. Medially located tibial and talar osteophytes go undetected on the standard AP and lateral X-ray. This 3D animatio...

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An unexpected finding

A large loose body (arrow) was coincidentally found during an anterior ankle arthroscopy. (Picture 1) A 37-years old male patient with deep ankle pain due to localised lateral talar OCD underwent a...

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Second look: 4 years after implantation of a HemiCap

In this 41 years old patient a HemiCap was implanted for a secondary posteromedial talar OCD. The deep ankle pain completely resolved but the malleolar screws were removed. During the screw removal a ...

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Anterior impingement due to anterior capsular avulsion

A 25-years old male basketball player with tenderness anterior. Picture 1: The CT shows anterolateral capsular avulsion/calcification (encircled). Picture 2: Endoscopic view before rem...

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Talar osteophyte

Picture 2: Anteromedial impingement view (AMI view ) on the right ankle demonstrating the talar osteophyte (arrow). Picture 3: Endoscopic view with the scope in the anterolateral por...

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Length rupture peroneus brevis tendon

A 60-years old male patient with lateral pain on the right ankle. No trauma history. With palpation there is a tenderness and swelling posterolateral over the peroneal tendon. Picture 1: MRI i...

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Incidental finding during arthroscopy

During arthroscopy on the left ankle of a 22 years old patient, there was an incidental finding. With inspection a thick fibrous layer was covering the cartilage of the talus. It could easil...

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Peroneal tendon (sub)luxation

A 20-years old female patient with recurrent peroneal tendon (sub)luxation. The lesion was successfully treated with an endoscopic groove deepening procedure. ...

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Unusual location for a talar cyst

A 61-years old female patient with deep ankle pain in the left ankle. A posterior arthroscopy with debridement and micro fracturing was performed. Picture 1: CT scan showing the cyst (approxim...

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Avulsion of anterolateral ankle joint capsule with calcifications

A 15-years old soccer player with persistent pain one year after distortion. With physical examination there is recognizable anterolateral tenderness on palpation. Picture 1: The X-ray shows c...

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Symptomatic cystic lesion medial malleolus

41-years old patient with deep ankle pain in the right ankle. Treatment was by debridement and bone marrow stimulation. Inspection by scope introduced through the medial portal looking posterior. T...

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Intraosseous calcaneal ganglion

48-years old patient with symptomatic intraosseous calcaneal ganglion. Picture 1: CT scan shows an intraosseous cyst in the calcaneuswith an opening in the posterior talocalcaneal joint near t...

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Elite runner with anterolateral pain

A 22-years old female elite runner with persistent anterolateral pain on the left ankle. Picture 1 + 2: On the MRI we see intra-articular fluid(as a sign of irritation) with an intra...

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Second look 15 months after HemiCAP implantation

27-years old female patient with a posteromedial Talar OCD right side. Previously unsuccessfully treated with debridement and drilling. Hemicap was implanted. During a second look, for removal of...

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Peroneus Quartus tendon

A 21 years old male patient visited the outpatient clinic for lateral ankle pain of his left ankle. There was pain over the peroneal tendons on palpation with loss of strength...

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Painful Foot

Picture 1: A 10-year old girl with pain and swelling over her 2nd, 3rd and 4th MTP-joints. Diagnosis: A 10-years old boy presented with pain and swelling over his right foot fo...

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An unexpected finding

A 37-years old male patient with deep ankle pain due to localised lateral talar OCD underwent anterior ankle arthroscopy. In the anterior working space a loose body was found. After res...

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Peroneal Groove Deepening

In 1803 Monteggia was the first to describe peroneal tendon dislocation in a female ballet dancer. These tendons dislocate if the superior peroneal retinaculum ruptures, frequently due to an inversion...

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Posterior Tibial Tendoscopy

In the absence of intra-articular ankle pathology, posteromedial ankle pain is most often caused by disorders of the posterior tibial tendon. Tendoscopy of the posterior tibial tendon proved to b...

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Removal of Loose Body

Loose bodies may result from minor to major trauma and arise from defects in the talus, tibia, fibula or osteophytes. They also may be caused by degenerative joint disease, and are either ch...

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Achilles tendoscopy

For the endoscopic management of mid-portion tendinopathy: CLICK HERE. ...

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FHL-tendon pathology

Picture 1: Endoscopic release of the Flexor Hallucis Longus tendon. Flexor hallucis longus (FHL) tenosynovitis is a well recognized cause of posteromedial ankle pain. In ballet dancers this en...

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FHL and tibial nerve

This shows the close relation between the Flexor hallucis longus tendon and the posterior tibial nerve. It emphasizes the importance of the FHL tendon as landmark in posterior ankle art...

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Post-traumatic phalangeal OCD in osteoartritic MTP-1 joint

After axial compression trauma during soccer, a 25 years old male experienced continuous deep pain of the right MTP-1 joint. Picture 1: MRI revealed a phalangeal OCD and signs of deg...

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Calcaneal Cyst Caused by Retrocalcaneal Bursitis

A 23 year old professional athlete with hindfoot pain (left). Conservative treatment with analgesics, an orthotic sole and shockwave therapy did not solve the complaints. Physical examinatio...

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Posterior Loose Body

20 years old female: two years before, successful debridement of a medial talar ocd. Currently, posteromedial ankle pain with FHL tendinitis. CT scan shows a rod-shaped bony fragment. Picture 1:&n...

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Accessory FHL retinaculum

Picture 1: Posterior ankle arthroscopy was performed in a patient with FHL-tendinitis of the left ankle. After complete detachment of the flexor retinaculum from the posterior talar process, the ...

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Sliding Calcaneal Osteotomy

Sliding Calcaneus Osteotomy is an established procedure for treatment of an acquired adult flatfoot, to correct hindfoot valgus in case of deltoid ligament insufficiency, cavovarus foot deformity, ost...

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Longitudinal Rupture Peroneus Brevis Tendon

A 37 years old male patient with persistent posterolateral ankle pain underwent a peroneal tendoscopy, after a longitudinal rupture of the peroneus brevis was identified on MRI.  Picture 1 and...

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Talar Cyst: Surgical Strategy

Situation after removal of unstable cartilage in a patient with a central talar ocd in the right ankle. Because of the highly sclerotic and dense bone it was not possible to enter the cyst. The openin...

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Dry Arthroscopy

Picture 1: Image quality is often better when arthroscopy is performed without fluid irrigation. ...

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Lateral ligament reconstruction

Anatomical reconstruction using the original ligament ends has been found to be technically simple, giving rise to few complications and producing satisfactory functional results in both the short- an...

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Second look after Hemicap

A 22 years old patient underwent implantation of a Hemicap prosthesis on the medial talar dome for a large OCD. She has been treated unsuccessfully with microfracturing before. After Hemicap implantat...

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Technical tip for inside-out anterolateral scope placement

Conventional introduction of the scope in the anterolateral portal can be difficult. The video shows an easy solution using an inside-out technique. For conventional portal placement technique...

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Initial limited visibility of talar OCD

Technical detail to visualize medial talar OCD in forced plantar flexion A 29 years old male patient with persistent deep ankle pain underwent arthroscopic micro fracturing of a large talar osteoch...

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Accessory tendon posteromedial to the FHL tendon

A 27 years old male patient underwent a posterior arthroscopy for posterior impingement complaints due to hypertrophic scar tissue. Two years before the patient underwent posterior arthroscopy for a p...

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5 Tips for removal of broken instrument intra-articular

Broken tip of 11 blade. Blade broke when creating posteromedial portal for endoscopic calcaneoplasty. 'Freeze' once the broken instrument comes into view. Don't use waterflow in orde...

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Don't forget the washer

A 50 year old patient with anterior ankle impingement underwent anterior ankle arthroscopy for screw removal. The screw was inserted for fixation of a bimalleolair ankle fracture 5 years bef...

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Mirror Image

Orientation in an ankle with ankle prosthesis can be difficult: A 70 year old male patient with left sided anteromedial ankle impingement underwent anterior ankle arthroscopy. Patient had an ank...

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Posterolateral Ankle Pain

A 52 year old patient with persistent posterolateral ankle pain after recurrent supination trauma. Normal ROM, stable ankle and tenderness over peroneal tendons. Tendoscopy shows a longitudinal l...

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Check the Head

Picture 1: In case of arthroscopic screw removal it is important to fully clear the screw head from ingrown soft tissue before applying the appropriate screwdriver. Picture 2: Radiograph showi...

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Plantaris Tendon Release

A 40 year old patient underwent tendoscopy of his right Achilles tendon for long lasting midportion Achilles tendinopathy. The arrow points towards the plantaris tendon which is often f...

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Transverse Ligament Rupture

A year 25 year old professional altlete with persisting posterolateral deep ankle pain after an eversion trauma. On a MRI scan a partial rupture of the transverse ligament was seen with scar tiss...

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Wrong Portal Placement

A 21 year old female patient underwent anterior ankle arthroscopy to debride and microfracture an medial talar osteochondral defect. As the medial portal was created too medial it was not possible to ...

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Medial Talar OCD; Debridement and Microfracturing

There are various published surgical techniques for treatment of symptomatic osteochondral lesions. Generally these are based on one of the following three principles: Debridement and bone marro...

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Cycle for Science tour 2016, Amsterdam - Barcelona

The first Cycle for Science Tour toke place in 2016. A group of 40 orthopedic surgeons and members of Ankleplatform rode from the 2014 ESSKA hosting city, Amsterdam, to the 17th biennial Con...

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Peroneal groove deepening

Picture 1: Peroneal groove deepening. Picture 2: View from posteromedial portal after opening of the peroneal tendons sheat: Peroneal (1), Posterior talofibular ligament (2), Subtalar joi...

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Fracture through existing stress fracture in medial malleolus

Description of patient: A 24-years-old professional athlete. History and previous treatment: Left ankle trauma in hyperplantar flexion one months before the patient was seen at our patient clinic...

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Ankleplatform initiative in collaboration with Professor Jean Brilhault

In collaboration with Professor Jean Brilhault, from the Department of Orthopedics and Trauma in Hôpital Trousseau in France, we have produced a series of surgical technique video's for correction of...

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Careful pre-operative planning

This 26-years old patient was treated for a distal tibia fracture on the left side. 4 years later she had a correction osteotomy because of an intra-articular step-off. On investigation there is recog...

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Ganglion cyst

A 47-year-old male patient with posterior ankle pain on the right side. Sometimes a snap and there locking occurs. Rotational movements are painful. During physical examination there is a recognizable...

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FHL Tendinopathy

A 22 years old male professional ballet dancer with complaints of the left ankle. Dancing is not possible because of the posterior ankle pain and he describes locking complaints of the flexo...

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