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 osteochondral defect located in the left ankle. Patient underwent retrograde drilling for the same defect two years before, however the inability to sport remained.

Technical tip:
With the ankle in full plantar flexion, anteromedial synovial tissue will always interfere and block the view on the medial talar OCD. Perform limited synovectomy. This synovectomy can best be performed with the ankle in dorsiflexion. After this limited synovectomy the OCD can be inspected with the ankle in full plantar flexion. (picture 3 and 4)

Picture 1: Picture showing hypertrophic synovial tissue during anterior ankle arthroscopy, which blocks the view on the medial talar osteochondral defect.

Picture 2: CT scan showing a large OCD at the medial side of the talus.

Picture 3: Picture showing clear view of tibia (1), talus (2) and OCD (3) after limited synovectomy with the ankle in dorsiflexion.

Picture 4: Picture showing OCD after micro fracturing.