This 28-year-old recreational football player presented with a six-month history of recurring ankle pain and swelling. The player reported a history of multiple previous ankle sprains.
On examination the ankle was visible swollen. There was a global restriction of ankle movements – especially weight-bearing dorsiflexion. There was also evidence of past ankle instability with an increased anterior draw.
The AP x-ray image shows a tiny abnormality involving the lateral talar dome. This has been further demonstrated on the cross sectional imaging. The MRI has shows that the lesion is located on the postero-lateral aspect of the tibia. It is associated with some relatively significant subchondral oedema. The imaging also showed evidence of an associated injury to the lateral ligament complex.
Injuries to the talar dome should be suspected when a player presents with chronic ankle pain following an injury to the ankle. The most common presenting symptoms are pain, swelling and locking/jamming. They generally occur to either the anterolateral or posteromedial ankle. Lateral talar dome injuries are more likely to be associated with direct trauma.
Low-grade injuries are initially managed non-surgically with limited weight-bearing and a cycling programme for a minimum of three months. Higher-grade posteromedial injuries may also be better managed conservatively initially as they do less well with surgical management. High-grade injuries or injuries that fail to improve are generally managed arthroscopically. The best predictor of outcome is the size and location of the lesion. Lesions that are located anteriorly and are less than 150mm2 do better than larger, more posterior lesions. Options include excision and drilling as well as open reduction and internal fixation if the defect is large (especially in young patients).
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