Osteochondral lesion of talar dome Case for small group discussion AOTrauma—Foot & Ankle Module 16: Sports injuries Per-Henrik Agren, SE

Case description 28-year-old woman, referred as osteochondral lesion (OCL) of talar dome Injury on trampoline 4 years ago MRI suggests lateral ligament disruption and medial talar dome lesion with osteophytes Constant pain Pain after jogging Cannot wear heels Varus

Preoperative x-ray

Preoperative x-ray

MRI scans

MRI scans

Procedure Medial approach Chevron osteotomy of medial malleolus for visualization and access Resect all osteophytes and deformity Lateral heel shift of calcaneus for foot alignment

Postoperative x-ray

Postoperative x-ray

4 months postoperative

4 months postoperative

4 months postoperative

4 months postoperative

4 months postoperative

Take-home messages Although not a typical OCL but rather a shearing fracture of medial talus this illustrates: Varus morphotype can aggravate or even produce lateral ankle instability and worsen symptoms of OCLs High incidence of OCLs after ankle fractures and ligament ruptures Treat associated deformities with OCLs