Recurrent Atraumatic Ankle Pain In An Adolescent Female Athlete - Page #4

Working Diagnosis:
Osteochondritis Dissecans of Right Talar Dome

Right ankle arthroscopy with retrograde drilling of talar osteochondral lesion, medial and lateral gutter synovectomy

Patient was immobilized in short leg cast and made non weight bearing for 6 weeks post-operatively. At 6 weeks, repeat X-rays showed mild improvement. Cast removed and patient started physical therapy. X-rays and CT scan were also performed at 3 months post-operatively with continued improvement. Patient was able to return to sport 6 months after surgery.

Editor's Comments:
In a patient with chronic ankle pain, OCD is an important piece of the DDx. Severe osteochondral lesions associated with loose bodies may lead to early arthritis and chronic pain if diagnosis and treatment are delayed. Most common symptoms are pain and swelling, with less common stiffness and locking. Etiology is not known, with many suggesting post-traumatic or associated with longer term ankle instability. Initial conservative therapy is appropriate for lesions grades I-III. Our patient presented with imaging concerning for a grade IV lesion, which would be an indication for surgical intervention.

Recent review article
Talusan PG. et. al. Osteochondritis Dissecans of the Talus. Clin Sports Med 33 (2014) 267-284

Am Fam Physician. 2000 Jan 1;61(1):151-156.

Am J Sports Med. September 2006 vol. 34 no. 9 1450-1456.

Brukner and Kahn. Clinical Sports Medicine. p. 806-825.

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