Osteochondritis dissecans of the talar dome treated with an osteochondral autograft.

Abstract

version injury. He was treated with immobilization for 6 weeks. Radiographs showed excellent fracture alignment with evidence of satisfactory healing. Two months later, he began to experience anterior right ankle pain on walking distances. He also experienced pain and stiffness after prolonged periods of sitting and on getting out of bed in the mornings. Examination revealed a full range of motion (with pain on dorsiflexion) and no swelling or tenderness of the right ankle. There was no locking or catching. Radiography (Fig. 1) revealed an area of lucency in the right medial talar dome. Magnetic resonance imaging (MRI) (Fig. 2) showed an osteochondral fracture (11 × 6 × 11 mm) of the superomedial talar dome with adjacent marrow edema. There was no deformity of the articular surface or any loose fragments. The patient was managed conservatively with restriction of activities. Six months later the symptoms persisted along with the new finding of tenderness over the anterior aspect of the ankle. A computed tomography arthrogram (Fig. 3) showed a sclerotic lesion with cystic change in the medial talar dome without any flattening of the articular cartilage. No contrast was seen between the lesion and the underlying bone. Subsequent arthroscopy revealed a large flap of carti