I need again your advice:
This patient is a colleague of mine, a cardiologist, who had an ankle
sprain 10 years ago. He does not do a lot of sport. Normal weight.
*Five years ago *he did an MRI (no symptoms) and there was an old
osteochondral defect of the medial aspect of the talus and a huge
intraosseous cyst/geode inside the talus, close to the osteochondral lesion
(probably secondary to the OCD)
Orthopedist explained back then standard treatment would osteochondral
allograft for osteochondral lesion but it is difficult to do because of the
cyst/geode
*5 years later – little/moderate pain in the ankle*
The same old osteochondral lesion, stable in my opinion, although there is
slight increase in signal at the border between fragment and talus (small
fluid possibly or just different mri parameters)
Same cyst/geode which now is a bit smaller with inhomogeneous content
probably some small hemorrhage inside (collapse of the cyst?)
AND some BME around the cyst
My opinion is that probably the BME is due to mechanical failure of the
bone around the cyst and probably it is the cause of the pain.
The osteochondral lesion is stable, exists for at least 10 years and I
suppose it is asymptomatic.
*Questions:*
– am I wrong? the OCD could be symptomatic although it is stable for 10
years?
– how can he treat this problem? (bone graft for the cyst, and
osteochondral allograft for the OCD, probably in two distinct surgery –
said the orthopedist) – my fear is that the cyst will completly collapse
and then the whole talus will suffer
– is there any percutaneous possibility to inject cement or something else
inside the geode and see if this solves the pain?
– can you recommend an orthopedic center / orthopedist in Europe where they
can do the surgery / or percutaneous intervention needed?
Thank you again!
Sorin
images: left 2022, right 2017
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