Severe bilateral cystic osteochondral lesion of the talus: A case report

Abstract

Osteochondral lesion of the talus (OLT) affects the articular cartilage and subchondral bone and may progress to osteonecrosis and cystic degeneration. We report the case of a patient with severe, bilateral OLT with expansive cystic lesions, with no history of trauma or joint instability, but with subtle varus deformity of the hindfoot. Following imaging tests, an osteochondral lesion was suspected, with a differential diagnosis of cystic neoplasm. Treatment consisted of an arthroscopy to assess the ankle joint, followed by medial access with an osteotomy of the medial malleolus for osteochondroplasty of the OLT (curettage, autologous bone grafting, and coverage with a biological membrane), combined with axis alignment via a valgus osteotomy of the calcaneus. The anatomopathological examination confirmed OLT. The patient showed good clinical progress on follow-up imaging. This case contributes to the literature by describing a rare, bilateral, severe presentation of OLT with no relevant predisposing factors, as well as a favorable response to complex surgical treatment. It reinforces the disease’s variability, which can range from mild forms to challenging conditions. Level of evidence IV; Case Report