9 Year Old Female Athlete With Ankle Pain - Page #4

Working Diagnosis:
Left Ankle: Osteochondritis dissecans distal tibial epiphysis with 1 cm leg length discrepancy.

Right Foot and Ankle: Reactive bone edema due to altered biomechanics

Patient was made non-weightbearing and placed into a short leg cast on the left for 6 weeks. This was followed by 2 weeks in a walking cast.
After cast removal she progressed to rehab and gradual return to activity.

Left medial ankle was tender 3 weeks after casting. The Right foot and ankle remained nontender. Repeat left ankle x-rays was done at 6 weeks and MRI at 3 months. She did physical therapy for ROM, core strength, running/gait training. She may need possible surgical intervention for chronic pain

Author's Comments:
OCD lesions are generally unilateral as it is a disorder of the talar or distal tibial subchondral bone and articular cartilage. Incidence in children is not clearly well known. This case is unique as there is possibility that this could be a bilateral presentation of an OCD lesion.

Editor's Comments:
It is important to pursue more advanced imaging if a patient has persistent symptoms despite the typical treatment of immobilization and physical therapy. This is especially important in a growing athlete. Some osteochondral defects can go undetected on plain xray.

Kessler J, Weiss J, Nikizad H, Gyurdzhyan S, Jacobs J Jr, Bebchuk J, Shea K. Osteochondritis dissecans of the ankle in children and adolescents: demographics and epidemiology. Am J Sports Med. 2014, 42(9), 2165-2171.

Thacker M, Dabney K, Mackenzie W. Osteochondritis dissecans of the talar head: natural history and review of literature. J Pediatr Orthop B. 2012, 21(4), 373-376.

Weiss J, Nikizad H, Shea K, Gyurdzhyan S, Jacobs J, Cannamela P, Kessler J. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Orthop J Sports Med. 2016, 4(3), 1-7.

Zbojniewicz A, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014, 33(2), 221-250.


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